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1: IMPACT OF ICU ATTENDING PHYSICIAN TRAINING BACKGROUND ON OUTCOMES AFTER PEDIATRIC CARDIAC SURGERY

Bhaskar, Priya; Rettiganti, Mallikarjuna Rao; Gossett, Jeffrey; Gupta, Punkaj

doi: 10.1097/01.ccm.0000508719.11752.a9
Star Research Presentations: Pediatric, Administration and Quality

Learning Objectives: Pediatric cardiac intensive care is a field needing expertise in critical care, cardiology, neonatology, cardiac surgery and pharmacology. However, there is no consensus on the training of pediatric cardiac intensivists. To address this knowledge gap, we evaluated the impact of intensive care unit (ICU) attending physician training background on outcomes in children undergoing heart operations.

Methods: Patients ≤ 18 years undergoing heart surgery at a Pediatric Health Information Systems (PHIS) ICU were included (2010–2015). Based on the training background of majority of attending physicians in a particular ICU, we divided the participating ICUs in three groups: PICU, Cardiology and Indeterminate. Multivariable logistic regression models were fitted to evaluate association of ICU attending physician’s training background with study outcomes after adjusting for patient and center characteristics.

Results: A total of 54,935 patients from 43 ICUs were included. Of these, 31,815 patients (58%) were treated in the group with PICU predominant attending physicians (28 ICUs), 19,340 patients (35%) were treated in the group with Cardiology predominant attending physicians (10 ICUs), and 3,780 patients (7%) were treated in the group that were not able to be classified in any group (5 ICUs). In adjusted models, no specific group based on ICU attending physician training background was associated with significantly lower mortality (PICU vs. Cardiology, OR: 0.75, 95% CI: 0.48–1.18; Indeterminate vs. Cardiology, OR: 0.86, 95% CI: 0.42–1.78), or lower incidence of cardiac arrest (PICU vs. Cardiology, OR: 0.71, 95% CI: 0.47–1.06), or prolonged hospital length of stay (PICU vs. Cardiology, OR: 1.39, 95% CI: 0.83–2.31), or prolonged mechanical ventilation (PICU vs. Cardiology, OR: 0.86, 95% CI: 0.24–3.04).

Conclusions: This multicenter, large observational study did not demonstrate any impact of ICU attending physician training background on outcomes (including mortality) in children undergoing heart operations.

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