Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery

作者：Ambrose Stephanie E; Ongkasuwan Julina; Dedhia Kavita; Diercks Gillian R; Anne Samantha; Shashidharan Subhadra; Raol Nikhila^*

来源：JAMA Otolaryngology-Head & Neck Surgery, 2018, 144(5): 406-412.

DOI：10.1001/jamaoto.2017.3459

IMPORTANCE Vocal fold motion impairment (VFMI) is a known risk factor following congenital heart surgery (CHS). The impact of this diagnosis on utilization and outcomes is unknown.
OBJECTIVE To evaluate the cost, postprocedure length of stay (PPLOS), and outcomes for neonates with VFMI after CHS.
DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of the 2012 Kids' Inpatient Database (KID) of neonates who underwent CHS was carried out. The KID is an administrative data set of patients, aged 20 years or younger, and contains data on more than 10 million hospitalizations from 44 states. The KID is limited to inpatient hospitalization and contains discharge summary level of data. Patients were limited to those who were born during the hospitalization and those who were aged 28 days or younger at the time of admission for CHS. A weighted total of 4139 neonates who underwent CHS were identified, of which 3725 survived. The proportion of neonates diagnosed with VFMI was 264 (6.92%) of 3725.
EXPOSURES Congenital heart surgery.
MAIN OUTCOMES AND MEASURES Cost of inpatient hospital stay, postprocedure length of stay, odds of pneumonia, gastrostomy tube placement, and tracheostomy tube placement. Risk-adjusted generalized linear models examined differences in cost and PPLOS between neonates who underwent CHS and were diagnosed with VFMI and those who were not. Risk-adjusted logistic regression compared the odds of selected outcomes (gastrostomy, tracheostomy, pneumonia). Models were weighted to provide national estimates. RESULTS Of 3725 neonates (aged 0-28 days), 2203 (59.1%) were male and 1517 (40.7%) were female. Neonates diagnosed with VFMI had significantly higher total cost by $34000 (95% CI, 2200-65000) and PPLOS by 9.1 days (95% CI, 4.6-13.7) compared with those who did not. When PPLOS was included as a covariate in the model for cost, presence of VFMI was no longer significant. There were no differences in odds of pneumonia, gastrostomy, or tracheostomy.
CONCLUSIONS AND RELEVANCE Vocal fold motion impairment after CHS was associated with significant increases in cost owing to increased PPLOS. These findings provide a foundation to further investigate standardized screening for VFMI following CHS; early identification and treatment may decrease cost and PPLOS.

• 出版日期2018-5