Prolonged Length of Stay After Elective Same-Day Admissions for Pediatric or Congenital Cardiac Catheterizations: A Potential Measure for Procedural Harm

Abstract

Background

Although adverse events (AEs) are common during congenital cardiac catheterization procedures, many have little impact beyond the catheterization laboratory. We sought to identify factors that are associated with an increased length of stay (LOS).

Methods

A total of 10,882 cases from the C3PO-quality improvement registry dataset from January 2014 to December 2017 admitted electively on the same day of cardiac catheterization were analyzed and independent risk factors for a prolongation of LOS were identified.

Results

Length of stay ranged from 0 to 305 days. The incidence of higher severity AE was significantly higher for cases that had a hospital stay of 2 days or more, compared to those discharged the same day or day 1 after the procedure (15% vs 2%, P < .001). Seven percent of patients without any AE in the cardiac catheterization laboratory had a prolonged LOS of 2 days or more. Significant independent risk factors for a prolongation of LOS included age <1 year, single ventricle diagnosis, cardiac surgery within the last 90 days, a higher hemodynamic vulnerability score, a higher PREDIC³T risk category, a prolonged procedure time, contrast usage >6 mL/kg, operators experience of either <5 or ≥25 years, and operator case volume >200 cases/y. The presence of any level 3bc, 4, or 5 AE had the highest associated odds of an increased LOS (OR, 5.9; 95% CI, 4.6-7.6).

Conclusions

Prolonged admission after outpatient catheterization is a potential alternative measure of safety after pediatric or congenital cardiac catheterization. It is independently associated not only with patient, procedure, and operator factors that have previously been described to be associated with the risk of AE but also with other factors such as the presence of single ventricle physiology. Further studies are needed to further evaluate its utility.