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P07 Predictors of hospital length of stay following complete repair of tetralogy of fallot in a paediatric cohort in the North of England
  1. Adenike Motunrayo Adesanya1,
  2. Kate E Best2,
  3. Louise Coats1,3,
  4. Judith Rankin1,4
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
  2. 2Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  3. 3Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  4. 4NIHR, Applied Research Collaboration North East and North Cumbria, Newcastle Upon Tyne, UK

Abstract

Background Congenital heart disease (CHD) is the most common group of congenital anomalies, with Tetralogy of Fallot (ToF) being the most common complex, cyanotic CHD. The number of procedures performed to correct or palliate CHD in children in the UK has risen steadily over time. Information on hospital length of stay (HLOS) is important for parents, commissioners and health professionals. There is a paucity of information regarding predictors of HLOS following paediatric CHD repair in the UK. The aim of this study was to estimate the median HLOS and to identify predictors of HLOS following ToF repair in children presenting to a Level 1 (surgical) CHD centre in the North of England.

Methods The National CHD Audit dataset was used to identify patients with ToF. We included patients aged <2 years at operation who underwent surgical repair for ToF between 1 January 1986 and 13 May 2022. Multiple imputation with chained equations was performed with 20 imputations to estimate missing values. Univariable and multivariable quantile regression was performed to examine the association between median HLOS and predictors.

Results There were 224 patients (59.4% male, Median age = 9 months, interquartile range 5–13 months) that underwent ToF repair, with a median HLOS of 9 days (IQR 7–13). In the univariable regression, for each month increase in age at operation, the median HLOS decreased by 0.17 days {β=-0.17(95%CI:-0.33, -0.01)}, and for each kg increase in weight at operation, the median HLOS decreased by 0.53 days {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)}, total bypass time (mins) {β=0.03(95%CI:0.01, 0.05)}, cross-clamp time (mins) {β=0.3(95%CI:0.01, 0.06)} and duration of post-operative intubation (days) {β=0.81(95%CI:0.67, 0.96)} were associated with increased HLOS in univariable models. There were no significant univariable associations with year of procedure, ethnicity, gender, comorbidities or socioeconomic status. In the multivariable models, previous cardiac or thoracic procedure {β=4.75(95%CI:1.66, 7.85)} and duration of post-operative intubation {β=0.76(95%CI:0.56, 0.96)} significantly predicted HLOS.

Discussion Identifying predictors of HLOS ensures adequate resources (e.g. beds, special care nurses) are available; health professionals are able to develop algorithms to minimise HLOS while maintaining health outcomes; and parents are able to make informed decisions about pregnancy continuation prenatally and make practical arrangements (e.g. leave from work, childcare for siblings) postnatally. 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.

  • Tetralogy of Fallot
  • Hospital Length of Stay
  • North of England

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