講演情報
[III-P02-1-01]The Association Between a Rigorous Integrated Treatment Model and Improved Hospital Outcomes in Neonates with Critical Congenital Heart Disease
○Chenyu Li, Xu Wang, Xiaofeng Wang, Zhongyuan Lu (Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China)
キーワード：
Neonatal cardiac surgery、Congenital heart disease、Outcome
Objective: Leveraging cross-center differences in the neonatal referrals, we evaluated the effect of our rigorous integrated management model compared to the conventional strategy for neonates with congenital heart disease(CHD).
Methods: We retrospectively analyzed neonates (≤30 days) who underwent CHD surgery at our center between January 2019 and October 2024. Subjects were divided into two groups: Group 1 included neonates managed under the integrated treatment model, which involved prenatal CHD diagnosis, birth in the designated maternity hospital, and transfer to our center via a green channel for cardiac surgery. Group 2 included neonates transferred from other hospitals or self-referred. Major adverse events(MAEs) were defined as in-hospital death or discharge against medical advice (DAMA). Multivariable logistic regression models were used to assess the association between different strategies and outcomes.
Results: 430 neonates were analyzed, with 112 in Group 1 and 318 in Group 2. MAEs occurred in 28 patients (6.5%). Neonates managed under our integrated treatment model were admitted to CICU on the day of birth (0 vs 9 days, P<0.001) and operated on earlier (7 vs 9 days, P<0.001). They also had a lower incidence of low birth weight (<2.5kg: 3.5% vs 11.6%, P=0.014). After adjusting for confounding factors, our integrated model was associated with fewer MAEs (odds ratio, 2.81; 95% confidence interval, 0.78 ~ 10.21).
Conclusion: Our model ensures safety and timeliness of neonatal transportation, optimizes preoperative conditions for high-risk neonates, and reduces MEAs.
Methods: We retrospectively analyzed neonates (≤30 days) who underwent CHD surgery at our center between January 2019 and October 2024. Subjects were divided into two groups: Group 1 included neonates managed under the integrated treatment model, which involved prenatal CHD diagnosis, birth in the designated maternity hospital, and transfer to our center via a green channel for cardiac surgery. Group 2 included neonates transferred from other hospitals or self-referred. Major adverse events(MAEs) were defined as in-hospital death or discharge against medical advice (DAMA). Multivariable logistic regression models were used to assess the association between different strategies and outcomes.
Results: 430 neonates were analyzed, with 112 in Group 1 and 318 in Group 2. MAEs occurred in 28 patients (6.5%). Neonates managed under our integrated treatment model were admitted to CICU on the day of birth (0 vs 9 days, P<0.001) and operated on earlier (7 vs 9 days, P<0.001). They also had a lower incidence of low birth weight (<2.5kg: 3.5% vs 11.6%, P=0.014). After adjusting for confounding factors, our integrated model was associated with fewer MAEs (odds ratio, 2.81; 95% confidence interval, 0.78 ~ 10.21).
Conclusion: Our model ensures safety and timeliness of neonatal transportation, optimizes preoperative conditions for high-risk neonates, and reduces MEAs.