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Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol
- Source :
- The Journal of thoracic and cardiovascular surgery. 150(3)
- Publication Year :
- 2015
-
Abstract
- Background Persistent pleural effusions after the Fontan procedure contribute to prolonged hospitalization and increased costs. We report our experience using a modified Wisconsin Fontan protocol to reduce chest tube drainage and hospital length of stay (LOS). Methods Single institutional retrospective chart review of 120 consecutive patients (60 before and 60 after initiation of our protocol) undergoing an extracardiac Fontan procedure from January 2004 to February 2007. Protocol influence was assessed by comparing group differences on duration of pleural drainage, requirement for nothing by mouth/total parenteral nutrition, hospital LOS, readmission for pleural effusion, and total hospital costs. Results Groups were similar in demographic characteristics, single ventricle morphology, preoperative hemodynamic parameters, and operative and immediate postoperative management. Median duration of pleural drainage and hospital LOS was reduced in the post- versus preprotocol groups: 4 days (interquartile range [IQR], 4-5 days) pre versus 6 days (IQR, 5-10 days) ( P P = .005), respectively. Pleural drainage lasting >1 week was also less common postprotocol: 23 (38%) before versus 7 (12%) after ( P = .001). Fewer postprotocol patients required nothing by mouth/total parenteral nutrition to control effusions: 5 pre versus 0 post ( P = .06), and fewer readmissions for effusions (14 before vs 7 after [ P = .1]). An average total cost savings of 22% and readmissions savings of 29% resulted in nearly $500,000 in institutional savings over the study period. Conclusions A modified Fontan protocol resulted in reduced time to chest tube removal, hospital LOS, and chest tube drainage lasting >1 week. There was a strong trend toward avoiding nothing by mouth/total parenteral nutrition to control pleural effusion and lower hospital costs.
- Subjects :
- Pulmonary and Respiratory Medicine
Heart Defects, Congenital
Male
medicine.medical_specialty
Nothing by mouth
Time Factors
Pleural effusion
medicine.medical_treatment
Fontan Procedure
Patient Readmission
law.invention
Fontan procedure
law
Interquartile range
Cost Savings
medicine
Cardiopulmonary bypass
Humans
Hospital Costs
Retrospective Studies
Postoperative Care
business.industry
Retrospective cohort study
Length of Stay
medicine.disease
Los Angeles
Surgery
Chest tube
Pleural Effusion
Parenteral nutrition
Treatment Outcome
Child, Preschool
Drainage
Female
Parenteral Nutrition, Total
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 1097685X
- Volume :
- 150
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Accession number :
- edsair.doi.dedup.....c7747e6cc234bb6c8702dff475167159