Hardisky Dariya, Satija Divyaam, Texter Karen, Alvarado Chance, Galantowicz Mark, Carrillo Sergio A
Department of Surgery, The Ohio State University, Columbus, Ohio.
The Ohio State University College of Medicine, Columbus, Ohio.
Ann Thorac Surg Short Rep. 2024 Mar 23;2(3):374-379. doi: 10.1016/j.atssr.2024.02.017. eCollection 2024 Sep.
Single-ventricle cardiac defects (SVCDs) are among of the most health care resource-intensive congenital diseases. Although SVCDs are traditionally palliated using the Norwood pathway, in the last 2 decades select programs have used the hybrid strategy, which redistributes the operative and interstage risks. This study sought to characterize resource use for a cohort of patients with hybrid-palliated SVCD.
All patients with SVCDs who underwent palliation with the hybrid strategy and who were followed up exclusively at our institution from January 2008 to December 2021 were included. End points were death, Norwood conversion, orthotopic heart transplantation, 6 months post-Fontan status, or 4 years of age in those patients who had not completed staged palliation. Primary end points included total days hospitalized, number of cardiology visits, echocardiograms, catheterizations, and advanced imaging performed.
Of 135 patients with a diagnosis of SVCD, 72 survived for 6 months after the Fontan procedure. By patient-year for the entirety of the pathway, patients had a median hospital length of stay of 16 days (interquartile range [IQR], 12-25 days), 7 cardiology visits (IQR, 6-9), 8 echocardiograms (IQR, 7-10), and 0.7 catheterizations (IQR, 0.4-1.1). The interstage 1 period had the heaviest resource burden requiring intense cardiology follow-up and echocardiography surveillance. Cardiac catheterizations and advanced imaging were most prevalent during interstage 2 period, with a median of 2 (IQR, 1-2) catheterizations and 36 (40%) patients undergoing advanced imaging. The total median number of hospital days per patient was 63 days (IQR, 47-98.5 days).
Resource use for the care of patients with SVCDs is significant. The intensity of surveillance decreases as patients progress through the pathway. In comparison with published Norwood pathway data, resource intensity and use patterns in hybrid palliation are comparable.
单心室心脏缺陷（SVCD）是医疗资源消耗最为严重的先天性疾病之一。尽管传统上采用诺伍德手术路径对SVCD进行姑息治疗，但在过去20年中，部分项目采用了杂交策略，该策略重新分配了手术风险和分期治疗期间的风险。本研究旨在描述接受杂交姑息治疗的SVCD患者队列的资源使用情况。
纳入2008年1月至2021年12月期间在本机构接受杂交策略姑息治疗且仅在本机构接受随访的所有SVCD患者。终点指标为死亡、转为诺伍德手术、原位心脏移植、Fontan手术6个月后的状态，或未完成分期姑息治疗患者的4岁时状态。主要终点指标包括总住院天数、心内科就诊次数、超声心动图检查次数、心导管检查次数以及进行的高级影像学检查次数。
在135例诊断为SVCD的患者中，72例在Fontan手术后存活6个月。在整个治疗路径中，按患者年计算，患者的中位住院时间为16天（四分位间距[IQR]，12 - 25天），心内科就诊7次（IQR，6 - 9次），超声心动图检查8次（IQR，7 - 10次），心导管检查0.7次（IQR，0.4 - 1.1次）。分期治疗1期的资源负担最重，需要密集的心内科随访和超声心动图监测。心导管检查和高级影像学检查在分期治疗2期最为普遍，中位心导管检查次数为2次（IQR，1 - 2次），36例（40%）患者接受了高级影像学检查。每位患者的总中位住院天数为63天（IQR，47 - 98.5天）。
SVCD患者的护理资源使用量很大。随着患者在治疗路径中的进展，监测强度会降低。与已发表的诺伍德手术路径数据相比，杂交姑息治疗中的资源强度和使用模式相当。
