Congenital Heart Center, Shands Children's Hospital, University of Florida.
Children's Hospital at Montefiore, Albert Einstein College of Medicine.
J Heart Lung Transplant. 2022 Sep;41(9):1248-1257. doi: 10.1016/j.healun.2022.05.016. Epub 2022 May 27.
Heart transplantation (HT) is the gold standard for managing end-stage heart failure. Multiple quality metrics, including length of stay (LOS), have been used in solid organ transplantation. However, limited data are available regarding trends and factors influencing LOS after pediatric HT. We hypothesized that various donor, peri-transplant and recipient factors affect LOS after pediatric HT.
We analyzed patients <18years at time of HT from January 2005 to December 2018 in the Pediatric Heart Transplant Society database, and examined LOS trends, defined prolonged LOS (PLOS = LOS>30days after HT), identified factors associated with PLOS and assessed outcomes.
Of 4827 patients undergoing HT, 4414 patients were discharged and included for analysis. Overall median LOS was 19days[13,34]. Median LOS was longer in patients with congenital heart disease(CHD = 25days[15,43] than with cardiomyopathy(CM = 17days[12,27] across all ages. Median LOS in age <1year was 26-days[16,45.5] and in age >10year was 16days[11,26]. PLOS was seen in 1313 patients(30%). Patients with PLOS were younger, smaller and had longer CPB times. There was no difference in utilization of VAD at HT between groups, however, ECMO use at listing(8.45% vs 2.93%,p < 0.05) and HT was higher in the PLOS group(9.22% vs 1.58%,p < 0.05). PLOS was more common in patients with previous surgery, CHD, single ventricle physiology, recipient history of cardiac arrest or CPR, end organ dysfunction, lower GFR, use of mechanical ventilation at HT and Status 1A at HT.
We present novel findings of LOS distribution and define PLOS after pediatric HT, providing a quality metric for individual programs to utilize and study in their practice.
心脏移植（HT）是治疗终末期心力衰竭的金标准。在实体器官移植中，已经使用了多种质量指标，包括住院时间（LOS）。然而，关于儿科 HT 后 LOS 趋势和影响因素的数据有限。我们假设各种供体、移植前和受体因素会影响儿科 HT 后的 LOS。
我们分析了 2005 年 1 月至 2018 年 12 月期间在儿科心脏移植协会数据库中接受 HT 的年龄<18 岁的患者，检查了 LOS 趋势，定义了延长 LOS（PLOS=HT 后 LOS>30 天），确定了与 PLOS 相关的因素，并评估了结果。
在 4827 例接受 HT 的患者中，有 4414 例患者出院并纳入分析。总体中位数 LOS 为 19 天[13,34]。在所有年龄段中，患有先天性心脏病（CHD=25 天[15,43]的患者的中位 LOS 长于患有心肌病（CM=17 天[12,27]。年龄<1 岁的患者中位 LOS 为 26 天[16,45.5]，年龄>10 岁的患者中位 LOS 为 16 天[11,26]。PLOS 见于 1313 例患者（30%）。PLOS 患者年龄较小、体型较小，CPB 时间较长。两组患者在 HT 时使用 VAD 无差异，但在 HT 时 ECMO 使用率（8.45%比 2.93%，p<0.05）和 PLOS 患者的 HT 率（9.22%比 1.58%，p<0.05）较高。PLOS 在有既往手术、CHD、单心室生理、受体心脏骤停或心肺复苏史、终末器官功能障碍、较低的 GFR、HT 时使用机械通气和 HT 时状态 1A 的患者中更为常见。
我们提出了儿科 HT 后 LOS 分布的新发现，并定义了 PLOS，为个别项目提供了一个质量指标，供其在实践中使用和研究。
