Standardized management improves outcomes after the norwood procedure

Chandra Srinivasan, Ritu Sachdeva, W. Robert Morrow, Jeff Gossett, Carl W. Chipman, Michiaki Imamura, Robert D B Jaquiss

Research output: Contribution to journalReview article

59 Citations (Scopus)

Abstract

Background. In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. Methods. Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. Results. Hospital survival (95% vs. 70%, P = .003) and survival to S2P (85% vs. 58%, P = .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P = .027) and survival to S2P (P =.049), while our home surveillance program was a predictor of survival to S2P (P = .016). Conclusion. Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.

Original languageEnglish (US)
Pages (from-to)329-337
Number of pages9
JournalCongenital Heart Disease
Volume4
Issue number5
DOIs
StatePublished - Sep 17 2009

Fingerprint

Norwood Procedures
Survival
Gastrostomy
Near-Infrared Spectroscopy
Perfusion
Phenoxybenzamine
Vocal Cords
Cardiopulmonary Bypass

Keywords

  • Hypoplastic left heart syndrome
  • Management
  • Norwood procedure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Srinivasan, C., Sachdeva, R., Morrow, W. R., Gossett, J., Chipman, C. W., Imamura, M., & Jaquiss, R. D. B. (2009). Standardized management improves outcomes after the norwood procedure. Congenital Heart Disease, 4(5), 329-337. https://doi.org/10.1111/j.1747-0803.2009.00323.x

Standardized management improves outcomes after the norwood procedure. / Srinivasan, Chandra; Sachdeva, Ritu; Morrow, W. Robert; Gossett, Jeff; Chipman, Carl W.; Imamura, Michiaki; Jaquiss, Robert D B.

In: Congenital Heart Disease, Vol. 4, No. 5, 17.09.2009, p. 329-337.

Research output: Contribution to journalReview article

Srinivasan, C, Sachdeva, R, Morrow, WR, Gossett, J, Chipman, CW, Imamura, M & Jaquiss, RDB 2009, 'Standardized management improves outcomes after the norwood procedure', Congenital Heart Disease, vol. 4, no. 5, pp. 329-337. https://doi.org/10.1111/j.1747-0803.2009.00323.x
Srinivasan C, Sachdeva R, Morrow WR, Gossett J, Chipman CW, Imamura M et al. Standardized management improves outcomes after the norwood procedure. Congenital Heart Disease. 2009 Sep 17;4(5):329-337. https://doi.org/10.1111/j.1747-0803.2009.00323.x
Srinivasan, Chandra ; Sachdeva, Ritu ; Morrow, W. Robert ; Gossett, Jeff ; Chipman, Carl W. ; Imamura, Michiaki ; Jaquiss, Robert D B. / Standardized management improves outcomes after the norwood procedure. In: Congenital Heart Disease. 2009 ; Vol. 4, No. 5. pp. 329-337.
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abstract = "Background. In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. Methods. Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. Results. Hospital survival (95{\%} vs. 70{\%}, P = .003) and survival to S2P (85{\%} vs. 58{\%}, P = .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P = .027) and survival to S2P (P =.049), while our home surveillance program was a predictor of survival to S2P (P = .016). Conclusion. Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.",
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AU - Srinivasan, Chandra

AU - Sachdeva, Ritu

AU - Morrow, W. Robert

AU - Gossett, Jeff

AU - Chipman, Carl W.

AU - Imamura, Michiaki

AU - Jaquiss, Robert D B

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N2 - Background. In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. Methods. Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. Results. Hospital survival (95% vs. 70%, P = .003) and survival to S2P (85% vs. 58%, P = .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P = .027) and survival to S2P (P =.049), while our home surveillance program was a predictor of survival to S2P (P = .016). Conclusion. Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.

AB - Background. In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. Methods. Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. Results. Hospital survival (95% vs. 70%, P = .003) and survival to S2P (85% vs. 58%, P = .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P = .027) and survival to S2P (P =.049), while our home surveillance program was a predictor of survival to S2P (P = .016). Conclusion. Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.

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KW - Management

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