Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project

• Published in: Journal of the American Heart Association Vol. 10; no. 21; p. e020730
• Main Authors: Bates, Katherine E, Connelly, Chloe, Khadr, Lara, Graupe, Margaret, Hlavacek, Anthony M, Morell, Evonne, Pasquali, Sara K, Russell, Jennifer L, Schachtner, Susan K, Strohacker, Courtney, Tanel, Ronn E, Ware, Adam L, Wooton, Sharyl, Madsen, Nicolas L, Kipps, Alaina K
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 02-11-2021; Wiley
• Subjects: cardiac surgical procedures; Cardiac Surgical Procedures - adverse effects; Chest Tubes; Child; congenital; heart defects; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Length of Stay; Original Research; Postoperative Complications - epidemiology; postoperative period; Time Factors; length of stay; postoperative period; heart defects; congenital; chest tubes; cardiac surgical procedures
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.020730

Background Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS. Methods and Results Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention-phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%,
=0.56) and readmission for pleural effusion (0.4% versus 0.5%,
=0.29). Conclusions We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.