Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient

Jay Yeh, Erin R. Brown, Kimberly A. Kellogg, Janet E. Donohue, Sunkyung Yu, Michael G. Gaies, Carlen G. Fifer, Jennifer C. Hirsch, Ranjit Aiyagari

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. Methods After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n = 118) and from June 2010 to August 2011 (late cohort; n = 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization. Results There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p = 0.004), ICU length of stay (18 vs 9 days, p = 0.01), hospital length of stay (30 vs 23 days, p = 0.005), and total durations of mechanical ventilation (11 vs 5 days, p = 0.02), chest tube use (20 vs 14 days, p = 0.01), central venous line use (27 vs 15 days, p = 0.001), and NPO status (9.5 vs 6 days, p = 0.04). Conclusions Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.

Original languageEnglish (US)
Pages (from-to)930-936
Number of pages7
JournalAnnals of Thoracic Surgery
Volume96
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Chylothorax
Practice Guidelines
Length of Stay
Artificial Respiration
Thoracic Surgery
Cardiac Surgical Procedures
Demography
Therapeutics
Chest Tubes
Equipment and Supplies
Pediatric Intensive Care Units
Octreotide
Practice Management
Hospital Mortality
Intensive Care Units
Early Diagnosis
Hospitalization
Guidelines
Morbidity
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. / Yeh, Jay; Brown, Erin R.; Kellogg, Kimberly A.; Donohue, Janet E.; Yu, Sunkyung; Gaies, Michael G.; Fifer, Carlen G.; Hirsch, Jennifer C.; Aiyagari, Ranjit.

In: Annals of Thoracic Surgery, Vol. 96, No. 3, 09.2013, p. 930-936.

Research output: Contribution to journalArticle

Yeh, J, Brown, ER, Kellogg, KA, Donohue, JE, Yu, S, Gaies, MG, Fifer, CG, Hirsch, JC & Aiyagari, R 2013, 'Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient', Annals of Thoracic Surgery, vol. 96, no. 3, pp. 930-936. https://doi.org/10.1016/j.athoracsur.2013.05.058
Yeh, Jay ; Brown, Erin R. ; Kellogg, Kimberly A. ; Donohue, Janet E. ; Yu, Sunkyung ; Gaies, Michael G. ; Fifer, Carlen G. ; Hirsch, Jennifer C. ; Aiyagari, Ranjit. / Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 3. pp. 930-936.
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abstract = "Background Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. Methods After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n = 118) and from June 2010 to August 2011 (late cohort; n = 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization. Results There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p = 0.004), ICU length of stay (18 vs 9 days, p = 0.01), hospital length of stay (30 vs 23 days, p = 0.005), and total durations of mechanical ventilation (11 vs 5 days, p = 0.02), chest tube use (20 vs 14 days, p = 0.01), central venous line use (27 vs 15 days, p = 0.001), and NPO status (9.5 vs 6 days, p = 0.04). Conclusions Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.",
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AU - Yeh, Jay

AU - Brown, Erin R.

AU - Kellogg, Kimberly A.

AU - Donohue, Janet E.

AU - Yu, Sunkyung

AU - Gaies, Michael G.

AU - Fifer, Carlen G.

AU - Hirsch, Jennifer C.

AU - Aiyagari, Ranjit

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N2 - Background Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. Methods After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n = 118) and from June 2010 to August 2011 (late cohort; n = 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization. Results There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p = 0.004), ICU length of stay (18 vs 9 days, p = 0.01), hospital length of stay (30 vs 23 days, p = 0.005), and total durations of mechanical ventilation (11 vs 5 days, p = 0.02), chest tube use (20 vs 14 days, p = 0.01), central venous line use (27 vs 15 days, p = 0.001), and NPO status (9.5 vs 6 days, p = 0.04). Conclusions Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.

AB - Background Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. Methods After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n = 118) and from June 2010 to August 2011 (late cohort; n = 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization. Results There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p = 0.004), ICU length of stay (18 vs 9 days, p = 0.01), hospital length of stay (30 vs 23 days, p = 0.005), and total durations of mechanical ventilation (11 vs 5 days, p = 0.02), chest tube use (20 vs 14 days, p = 0.01), central venous line use (27 vs 15 days, p = 0.001), and NPO status (9.5 vs 6 days, p = 0.04). Conclusions Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.

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