Hospital mortality for Norwood and arterial switch operations as a function of institutional volume
ABSTRACT Regionalization of complex surgical procedures to high-volume centers is a model for improving hospital survival. We analyzed the effect of institutional volume on hospital mortality for the Norwood and arterial switch operations (ASO) as representative high-complexity neonatal cardiac procedures. Analysis of discharge data from the 2003 Kids' Inpatient Database (KID) was conducted. Association between institutional volume and in-hospital mortality was examined for the ASO or Norwood procedure. Logistic regression analysis was performed to calculate the probability of hospital mortality for both procedures.Significant inverse associations between institutional volume and in-hospital mortality for the Norwood procedure (p </= 0.001) and the ASO (p = 0.006) were demonstrated. In-hospital mortality decreased for the ASO as institutional volume increased, with mortality rates of 9.4% for institutions performing two ASOs/year, 3.2% for 10 ASOs/year, and 0.8% for 20 ASOs/year. Similarly, in-hospital mortality rates for hypoplastic left heart syndrome were 34.8% for two Norwood procedures/year, 25.7% for 10 Norwood procedures/year, and 16.7% for 20 Norwood procedures/year. An inverse relation was observed between in-hospital mortality and institutional volume for ASO and the Norwood procedure. These results suggest that selective regionalization of complex neonatal cardiac procedures might result in significant improvement in hospital survival nationally.
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ABSTRACT: Background: The arterial switch operation (ASO) is the gold-standard surgical procedure for transposition of the great arteries (TGA) in newborns and small infants. The goal of this current study is to describe the postoperative respiratory care and the current outcomes of the patients that underwent ASO for TGA at our institute. Method: We retrospectively enrolled 28 patients (23 males and 5 females) with TGA, who underwent ASO in this institution between January 2006 and December 2008, and analyzed some parameters. The outcome measurements were length of ventilator support, re-intervention rate and survival during hospitalization. Results: Ages and body weights at ASO were 17.2 ± 32.3 days (median, 5 days; range, 0-158 days) and 3.1 ± 0.6 kg (median, 3; 1.3-5 kg), respectively. Partial cardio-pulmonary bypass (CPB) time was 231.8 ± 56.9 (163.0-377.0) minutes, total CPB time 192.8 ± 56.1 (134.0-308.0) minutes and aortic cross-clamp time 125.3 ± 36.0 (62.0-194.0) minutes. In this cohort, the mean ventilator duration was 12.8 ± 14.3 days (median, 7; range, 2-61) for all patients and 11.2 ± 11.3 days (median, 7; range, 3-50) for survivors. Yearly report showed that median ventilator duration was 17.5 days and survival was 73% in 2006, 8.6 days of ventilation and 100% survival in 2007, and 6.4 days of ventilation and 91% survival in 2008. Multivariate analysis showed patients with aortic coarctation had longer ventilation durations, possibly related to increased lung fluid caused by cardiopulmolnary bypass and increased left ventricular afterload. A higher re-intervention rate was found in patients with ventilation support > 14 days (p < 0.05). Conclusion: Ventilation duration shortened and survival rate increased gradually from 2006 to 2008. Patients with aortic coartation had longer ventilator support. Cardiorespiratory investigation or intervention was indicated in patients who required ventilation support more than 14 days postoperatively.
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ABSTRACT: Many possible autonomous underwater vehicle (AUV) missions require a high degree of navigational accuracy. The Global Positioning System (GPS) is capable of providing this accuracy. However, intermittent reception caused by either wave action or deliberate submergence will cause the loss of GPS position fix information for periods extending from several seconds to minutes. The SANS system is designed to demonstrate the feasibility of using a low-cost strapped-down inertial measurement unit to navigate between GPS fixes. It is anticipated that navigational accuracy comparable to GPS is possible between fixesAutonomous Underwater Vehicle Technology, 1996. AUV '96., Proceedings of the 1996 Symposium on; 07/1996