1. Abstract 14410: Modeling Postoperative Intensive Care Length of Stay to Improve Resource Management at Congenital Heart Centers
- Author
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Alexander, Peta M, Gauvreau, Kimberlee, Gaies, Michael G, DeWitt, Aaron G, Ge, Shirley, Ghanayem, Nancy, Lasa, Javier J, Kipps, Alaina, Mistry, Kshitij, Schwartz, Steven M, Shin, Andrew, Thiagarajan, Ravi R, and Bergersen, Lisa
- Abstract
Introduction:Predicting post-operative ICU length of stay (LOS) after congenital heart surgery (CHS) could inform scheduling, improve capacity management and model resource use variation.Hypothesis:A prediction model including patient characteristics and operative complexity at post-operative ICU admission can accurately predict ICU LOS >7 days. The model could be used to explore institutional differences in LOS.Methods:CHS admissions to 31 Pediatric Cardiac Critical Care Consortium (PC4) centers from April 2014 - September 2018 were identified. Hierarchical logistic regression with center-specific random intercepts identified variables associated with ICU LOS >7 days. The final model was used to compare risk-adjusted rates of ICU LOS>7 days across centers.Results:Of 29,113 CHS ICU admissions, 22.9% of the cohort had ICU LOS >7 days (range 1.8 - 41.2% by center). Important predictors of ICU LOS>7 days were STAT category (C=0.796) and pre-operative status (C=0.803), a descriptive composite of age, pre-operative mechanical ventilation, and pre-operative admission. Together, STAT category and pre-operative status were powerful predictors of ICU LOS>7 days (C=0.848, Table). Incorporation of post-operative characteristics of illness severity did not improve the model. Risk-adjusted rates for ICU LOS >7 days ranged from 10.8% to 40.5% (Figure).Conclusions:We developed a model to predict ICU LOS >7 days at postoperative ICU admission with excellent discrimination. We observed 4-fold variability in case-mix adjusted rates of ICU LOS>7 days across 31 centers. Further investigation is required to understand best practices and inform future quality initiatives.
- Published
- 2019
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