Factors Influencing Prolonged Hospital Stay in Surgically Treated Children and Adolescents with Left-to-Right Shunt Congenital Heart Disease: Evidence From a Hospital in Southern China.

Abstract

Background: Congenital heart disease(CHD) is a congenital malformation caused by abnormal development of the heart and large blood vessels, and left-to-right shunt CHD is a relatively common type. Surgical treatment has the problem of prolonged hospital stay in CHD patients. It is of great significance to explore the influencing factors of prolonged hospital stay after surgery therapy for children and adolescents with left-to-right shunt CHD.

Methods: A total of 463 children and adolescents with left-to-right shunt CHD who received surgery therapy were retrospectively analyzed. Medical records (gender, CHD types, echocardiography, invasive mechanical ventilation, blood transfusion, tracheal intubation, intraoperative blood loss, and length of hospital stay) were collected. The threshold for prolonged hospital stay was defined based on the third quartile (75th percentile) of length of hospital stay in all patients. The relationship between clinical features and prolonged hospital stay was analyzed.

Results: The mean length of hospital stay was 13.00 (7.00, 18.00) days, there were 330 (71.3%) patients with non-prolonged hospital stay (<18.0 days) and 133 (28.7%) with prolonged stay (≥18.0 days). There were statistically significant differences in the distributions of types of CHD (χ²=67.959, p<0.001), severity of mitral insufficiency (χ²=14.171, p=0.002) and pulmonary hypertension (χ²=49.611, p<0.001), and the proportion of treated with invasive mechanical ventilation (χ²=104.657, p<0.001), blood transfusion (χ²=117.649, p<0.001), and tracheal intubation (χ²=67.752, p<0.001) between CHD patients with prolonged and non-prolonged hospital stay. Multivariate logistic regression analysis showed that male (odds ratio(OR): 2.137, 95% confidence interval(CI): 1.278-3.574, p=0.004), compound types CHD (OR: 2.021, 95% CI: 1.178-3.469, p=0.011), pulmonary hypertension (OR: 3.179, 95% CI: 1.537-6.572, p=0.002), invasive mechanical ventilation (OR: 4.069, 95% CI: 1.567-10.564, p=0.004), and blood transfusion (OR: 5.128, 95% CI: 2.421-10.862, p<0.001) were independently associated with prolonged hospital stay.

Conclusion: Male, compound types CHD, pulmonary hypertension, invasive mechanical ventilation, and blood transfusion were independently associated with prolonged hospital stay in CHD patients. It provides valuable information to guide the hospitalization management of CHD.