Background:The
vasoactive-ventilation-renal (VVR) score includes pulmonary and renal
dysfunctions not previously addressed by the vasoactive inotrope score (VIS)
and may be a better predictor of cardiac care unit (CCU) length of stay (LOS)
in patients undergoing re-entry sternotomy (defined as no earlier than 30 days
after previous sternotomy) for congenital heart disease (CHD). Methods:Patients
undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016
were studied retrospectively. A total of 96 patients undergoing 133 re-entry
procedures were identified. VVR scores were calculated onCCU admission post-procedure (at 0 hour), 24-hour,
and 48-hour after admission to the CCU. The response variable was CCU LOS.？ Recursive partition analysis identified
variables predicting LOS. Results:133
re-entry sternotomies in 96 patients made up the samples of the database; 11
samples were removed due to incomplete data or placement on ECMO. Of the
initial 25 features, 5 were removed for near zero variance and 3 categorical
features were removed for non-information. Covariance analysis did not
demonstrate any significant correlation amongst the remaining features. Initial
recursive tree regression using ANOVA, cross validation and conditional
predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross
validation error was selected. The resulting 2 split trees with ventilator days
less than 20 days and VVR score at 48 hours greater than 23 identified three
CCU LOS groups with meanCCU LOS
of 77.6, 55.1, and 9.5 days.Conclusions:Recursive
partition analysis identified ventilator days greater than 20 days and the
sub-population VVR at 48 hours as predictive of CCU LOS in
References
[1]
Miletic, K.G., Spiering, T.J., Delius, R.E., Walters, H.L. and Mastropietro, C.W. (2015) Use of a Novel Vasoactive-Ventilation-Renal Score to Predict Outcomes After Paediatric Cardiac Surgery. Interactive Cardiovascular and Thoracic Surgery, 20, 289-295. https://doi.org/10.1093/icvts/ivu409
[2]
Gaies, M.G., Gurney, J.G., Yen, A.H., Napoli, M.L., Gajarski R.J., Ohye R.G., Charpie, J.R. and Hirsch, J.C. (2010) Vasoactive-Inotropic Score as a Predictor of Morbidity and Mortality in Infants After Cardiopulmonary Bypass. Pediatric Critical Care Medicine, 11, 234-238. https://doi.org/10.1097/PCC.0b013e3181b806fc
[3]
Miletic, K.G., Delius, R.E., Walter, H.L. and Mastropietro, C.W. (2016) Prospective Validation of a Novel Vasoactive-Ventilation-Renal Score as a Predictor of Outcomes after Pediatric Cardiac Surgery. The Annals of Thoracic Surgery, 101, 1558-1563. https://doi.org/10.1016/j.athoracsur.2015.11.006
[4]
Scherer, B., Moser, E.A., Brown, J.W., Rodefeld, M.D., Turrentine, M.W. and Mastropietro, C.W. (2016) Vasoactive-Ventilation-Renal Score Reliably Predicts Hospital Length of Stay after Surgery for Congenital Heart Disease. The Journal of Thoracic and Cardiovascular Surgery, 152, 1423-1429. https://doi.org/10.1016/j.jtcvs.2016.07.070
[5]
Mastropietro, C., Cashen, K., Narayana Gowda, K.M., Piggott, K., Wilhelm, M. and Costello, J. (2016) Multicenter Validation of the Vasoactive-Ventilation-Renal Score for Neonatal Cardiac Surgery. Critical Care Medicine, 44, 109. https://doi.org/10.1097/01.ccm.0000508807.03148.25
[6]
Follis, F.M., Pett, S.B. Jr, Miller, K.B., Wong, R.S., Temes, R.T. and Wernly, J.A. (1999) Catastrophic Hemorrhage on Sternal Reentry: Still a Dreaded Complication? The Annals of Thoracic Surgery, 68, 2215-2219. https://doi.org/10.1016/S0003-4975(99)01173-X
[7]
Özker, E., Saritas, B., Vuran, C., Yörüker, U., Ulugöl, H. and Türköz, R. (2012) Delayed Sternal Closure after Pediatric Cardiac Operations; Single Center Experience: A Retrospective Study. Journal of Cardiothoracic Surgery, 7, 102. https://doi.org/10.1186/1749-8090-7-102
[8]
Kirshbom, P.M., Myung, R,J., Simsic, J.M., Kramer, K.B., Leong, T., Kogon, B.E. and Kanter, K.R. (2009) One Thousand Repeat Sternotomies for Congenital Cardiac Surgery: Risk Factors for Reentry Injury. The Annals of Thoracic Surgery, 88, 158-161. https://doi.org/10.1016/j.athoracsur.2009.03.082
[9]
Jacobs, M.L., O’Brien, S.M., Jacobs, J.P., Mavroudis, C., Lacour-Gayet, F., Pasquali, S.K., Welke, K., Pizarro, C., Tsai, F. and Clarke, D.R. (2013) An Empirically Based Tool for Analyzing Morbidity Associated with Operations for Congenital Heart Disease. The Journal of Thoracic and Cardiovascular Surgery, 145, 1046-1057. https://doi.org/10.1016/j.jtcvs.2012.06.029
[10]
Davidson, J., Tong, S., Hancock, H., Hauck, A., da Cruz, E. and Kaufman, J. (2012) Prospective Validation of the Vasoactive-Inotropic Score and Correlation to Short Term Outcomes in Neonates and Infants After Cardiothoracic Surgery. Intensive Care Medicine, 38, 1184-1190. https://doi.org/10.1007/s00134-012-2544-x
[11]
Kumar, M., Sharma, R., Sethi, S.K., Bazaz, S., Sharma, P., Bhan, A, and Kher, V. (2014) Vasoactive Inotrope Score as a Tool for Clinical Care in Children Post Cardiac Surgery. Indian Journal of Critical Care Medicine, 18, 653-658. https://doi.org/10.4103/0972-5229.142174
[12]
Wernovsky, G., Wypij, D., Jonas, R.A., Mayer, J.E. Jr, Hanley, F.L., Hickey, P.R., Walsh, A.Z., Chang, A.C, Castañeda, A.R., Newburger, J.W. and Wessel, D.L. (1995) Postoperative Course and Hemodynamic Profile after the Arterial Switch Operation in Neonates and Infants. Circulation, 92, 2226-2235. https://doi.org/10.1161/01.CIR.92.8.2226
[13]
Garcia, R.U., Walters, H.L., Delius, R.E. and Aggarwal, S. (2016) Vasoactive Inotropic Score (VIS) as Biomarker of Short-Term Outcomes in Adolescents after Cardiothoracic Surgery. Pediatric Cardiology, 37, 271-277. https://doi.org/10.1007/s00246-015-1273-7
[14]
Haque, A., Siddiqui, N.R., Munir, O., Saleem, S. and Mian, A. (2015) Association between Vasoactive-Inotropic Score and Mortality in Pediatric Septic Shock. Indian Pediatrics, 52, 311-313. https://doi.org/10.1007/s13312-015-0630-1
[15]
Williams, F.Z., Sachdeva, R., Travers, C.D., Walson, K.H. and Hebbar, K.B. (2016) Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and its Clinical Significance. Journal of Intensive Care Medicine, 2016, Article ID: 885066616685247.
[16]
Bangalore, H., Gaies, M., Ocampo, E.C., Heinle, J.S., Guffey, D., Minard C.G., Checchia, P. and Shekerdemian, L.S. (2017) The Total Inotrope Exposure Score: An Extension of the Vasoactive Inotrope Score as a Predictor of Adverse Outcomes After Paediatric Cardiac Surgery. Cardiology in the Young, 27, 1146-1152. https://doi.org/10.1017/S1047951116002602
[17]
Akhtar, M.I., Hamid, M., Minai, F., Wali, A.R., Answar-UI-Haq, Aman-Ullah, M. and Ahsan, K. (2014) Safety Profile of Fast-Track Extubation in Pediatric Congenital Heart Disease Surgery Patients in a Tertiary Care Hospital of Developing Country: An Observational Prospective Study. Journal of Anaesthesiology Clinical Pharmacology, 30, 355-359. https://doi.org/10.4103/0970-9185.137267
[18]
Harris, K.C., Holowachuk, S., Pitfield, S., Sanatani, S., Froese, N., Potts, J.E. and Gandhi, S.K. (2014) Should Early Extubation Be the Goal for Children after Congenital Cardiac Surgery? The Journal of Thoracic and Cardiovascular Surgery, 148, 2644-2647. https://doi.org/10.1016/j.jtcvs.2014.06.093
[19]
Ödek, C., Kendirli, T., Ucar, T., Yaman, A., Tutar, E., Eyileten, Z., Tasar, M., Ramoglu, M, Ates, C., Uysalel, A., Ince, E. and Atalay, S. (2016) Predictors of Early Extubation after Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study. Pediatric Cardiology, 37, 1241-1249. https://doi.org/10.1007/s00246-016-1423-6
[20]
Marwali, E.M., Budiwardhana, N., Sastroasmoro, S., Pudjiadi, A. and Haas, N.K. (2013) Prediction Model for Length of Intubation with Assisted Mechanical Ventilation in Pediatric Heart Surgery. Critical Care & Shock, 16, 74-82.
[21]
Polito, A., Patorno, E., Costello, J.M., Salvin, J.W., Emani, S.M., Rajagopal, S., Laussen, P.C. and Thiagarajan, R.R. (2011) Perioperative Factors Associated with Prolonged Mechanical Ventilation after Complex Congenital Heart Surgery. Pediatric Critical Care Medicine, 12, e122-e126. https://doi.org/10.1097/PCC.0b013e3181e912bd
[22]
Székely, A., Sápi, E., Király, L., Szatmári, A. and Dinya, E. (2006) Intraoperative and Postoperative Risk Factors for Prolonged Mechanical Ventilation after Pediatric Cardiac Surgery. Pediatric Anesthesia, 16, 1166-1175. https://doi.org/10.1111/j.1460-9592.2006.01957.x
[23]
Tabib, A., Abrishami, S.E., Mahdavi, M., Mortezaeian, H. and Totonchi, Z. (2016) Predictors of Prolonged Mechanical Ventilation in Pediatric Patients after Cardiac Surgery for Congenital Heart Disease. Research in Cardiovascular Medicine, 5, 330-391. https://doi.org/10.5812/cardiovascmed.30391
[24]
Baker-Smith, C.M., Wilhelm, C.M., Neish, S.R., Klitzner, T.S., Beekman, R.H., Kugler, J.D., Martin, G.R., Lannon, C., Jenkins, K.J. and Rosenthal, G.L. (2014) Predictors of Prolonged Length of Intensive Care Unit Stay after Stage I Palliation: A Report from the National Pediatric Cardiology Quality Improvement Collaborative. Pediatric Cardiology, 34, 431-440. https://doi.org/10.1007/s00246-013-0797-y
[25]
Izenman, A.J. (2013) Recursive Partitioning and Tree-Based Methods. In: Izenman, A.J., Ed., Modern Multivariate Statistical Techniques, Regression, Classification and Manifold Learning, Springer Texts in Statistics, Springer, Berlin, 271-314. https://doi.org/10.1007/978-0-387-78189-1_9
[26]
Zhang, H. and Singer, B. (2010) Recursive Partitioning and Applications. In: Zhang, H. and Singer, B., Eds., Recursive Partitioning and Applications, 2nd Edition, Springer, Berlin, Chapters 1-4, 6, 8, 9. https://doi.org/10.1007/978-1-4419-6824-1
