Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway

Author:

Katz Alex J1,Lion Richard P2ORCID,Martens Timothy3,Newcombe Jennifer3,Razzouk Anees3,Shih Wendy4,Amirnovin Rambod2,Gordon Brent M5

Affiliation:

1. Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA

2. Department of Pediatrics, Division of Critical Care, Loma Linda University Children's Hospital, Loma Linda, CA, USA

3. Department of Cardiovascular and Thoracic Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA

4. School of Public Health, Loma Linda University, Loma Linda, CA, USA

5. Department of Pediatrics, Division of Cardiology, Loma Linda University Children's Hospital, Loma Linda, CA, USA

Abstract

Background Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks. Methods A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality. Results Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months. Conclusions Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology and Child Health,Surgery

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