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Alpha-blockade during congenital heart surgery admissions: analysis from national database

Part of: Basic Science

Published online by Cambridge University Press:  17 September 2021

Brian Lee ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Emad B. Mossad ,
Jacqueline Rausa ,
Ronald A. Bronicki ,
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]  and
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]
Brian Lee
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Enrique G. Villarreal*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
Emad B. Mossad
Affiliation:
Anesthesiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Jacqueline Rausa
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Ronald A. Bronicki
Affiliation:
Critical Care and Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Saul Flores
Affiliation:
Critical Care and Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Rohit S. Loomba
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
*
Author for correspondence: E. G. Villarreal, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México. Tel: +811 324 4817; Fax: (832) 825-2969. E-mail: [email protected]
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Abstract

Introduction:

The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes.

Materials and Methods:

A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality.

Results:

Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges.

Conclusions:

Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

Keywords

Adrenergic alpha-antagonistsCHDsphentolaminephenoxybenzamine mortalitylength of stay
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1136 - 1142
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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