Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Pediatr Cardiol. 2024 Jan;45(1):92-99. doi: 10.1007/s00246-023-03287-7. Epub 2023 Sep 12.
We sought to estimate the median post-operative length of stay (PLOS) and predictors of PLOS following tetralogy of Fallot (ToF) repair at a specialist surgical center in the North of England. The local National Congenital Heart Disease Audit dataset was used to identify patients aged < 2 years who underwent surgical repair for ToF between 1 January 1986 and 13 May 2022. Coefficients representing the median change in PLOS (days) according to predictors were estimated using Quantile regression. There were 224 patients (59.4% male, median age = 9 months, interquartile range (IQR) 5-13 months) with a median PLOS of 9 days (IQR 7-13). In the univariable regression, age (months) and weight (kg) at operation (β = - 0.17, 95% CI: - 0.33, - 0.01) and (β = - 0.53, 95% CI: - 0.97, - 0.10), previous (cardiac or thoracic) procedure (β = 5, 95% CI:2.38, 7.62), procedure urgency (elective vs urgent) (β = 2.8, 95% CI:0.39, 5.21), bypass time (mins) (β = 0.03, 95% CI:0.01, 0.05), cross-clamp time (mins) (β = 0.03, 95% CI:0.01, 0.06) and duration of post-operative intubation (days) (β = 0.81, 95% CI:0.67, 0.96), were significantly associated with PLOS. Previous procedure and intubation time remained significant in multivariable analyses. Some patient and operative factors can predict PLOS following complete ToF repair. Information on PLOS is important for health professionals to support parents in preparing for their child's discharge and to make any necessary practical arrangements. Health commissioners can draw on evidence-based guidance for resource planning. The small sample size may have reduced the power to detect small effect sizes, but this regional study serves as a foundation for a larger national study.
我们旨在评估英格兰北部一家专业外科中心接受法洛四联症（TOF）修复手术的患者术后住院时间（PLOS）中位数和 PLOS 预测因素。使用当地国家先天性心脏病审核数据集，确定了 1986 年 1 月 1 日至 2022 年 5 月 13 日期间接受 TOF 手术修复的年龄＜2 岁的患者。使用 Quantile 回归估计根据预测因素代表 PLOS 中位数变化的系数（天数）。共有 224 名患者（59.4%为男性，中位年龄为 9 个月，四分位距[IQR]为 5-13 个月），PLOS 中位数为 9 天（IQR 为 7-13 天）。在单变量回归中，手术时的年龄（月）和体重（kg）（β= -0.17，95%置信区间：-0.33，-0.01）和（β= -0.53，95%置信区间：-0.97，-0.10），先前的（心脏或胸部）手术（β=5，95%置信区间：2.38，7.62），手术紧急程度（择期与紧急）（β=2.8，95%置信区间：0.39，5.21），体外循环时间（分钟）（β=0.03，95%置信区间：0.01，0.05），主动脉阻断时间（分钟）（β=0.03，95%置信区间：0.01，0.06）和术后插管持续时间（天）（β=0.81，95%置信区间：0.67，0.96）与 PLOS 显著相关。多变量分析中，先前的手术和插管时间仍然具有统计学意义。一些患者和手术因素可以预测完全 TOF 修复后的 PLOS。PLOS 信息对卫生专业人员很重要，可帮助父母为孩子出院做准备，并进行任何必要的实际安排。卫生专员可以参考基于证据的资源规划指南。样本量小可能降低了检测小效应量的能力，但这项区域性研究为更大的全国性研究奠定了基础。
