Emergency department use after stage II palliation for children with single ventricle lesions.

BACKGROUND Infants born with a single cardiac ventricle require a 3-stage surgical palliation performed during the first few years of life for long-term survival. We aimed to determine the extent to which the emergency department services were used between the second and third surgical stages. METHODS A retrospective chart review was performed on patients who underwent stage II palliation at our institution between 2006 and 2011. Data analyses were performed using Mann-Whitney U tests or χ tests as appropriate. RESULTS Fifty patients underwent stage II palliation during the study period, 47 of which survived to hospital discharge. Thirty-one (66%) patients required 95 emergency department visits before stage III. The most common chief complaints were respiratory (n = 39) and gastrointestinal (n = 18 visits) in nature. Age and weight at time of stage II surgery, dominant ventricle, and data from discharge echocardiograms were not significantly different between patients who did and did not require emergency department visits. Median postoperative length of stay after stage II palliation was longer in patients using the emergency department, 11 (interquartile range, 6-17) versus 7 (interquartile range, 5-8) days, P = 0.015. Moreover, patients with lengths of stay greater than 10 days were 6 times more likely to require emergency department services (odds ratio, 6.0; 95% confidence intervals, 1.4-25.4). CONCLUSIONS Emergency department use by patients with a single cardiac ventricle is common after their second surgical stage, especially in patients with more complicated postoperative courses. This study emphasizes the important role of the emergency department in the care of these challenging patients.