Intensive care unit and acute care unit length of stay following congenital heart surgery

Abstract Background Postoperative length of stay (LOS) is an important quality metric and is known to vary widely across hospitals following congenital heart surgery. Whether this variability is explained by factors associated with the intensive care unit (ICU) or acute care unit (ACU) remains unclear. We evaluated the relationship between ICU and ACU LOS and the impact of ACU characteristics on post-operative LOS. Methods Congenital heart surgery hospitalizations within the Pediatric Cardiac Critical Care Consortium (PC4) registry (8/2014-2/2018) were included. Models were developed for ICU, ACU, and post-operative LOS adjusting for differences in case-mix across hospitals. PC4 hospitals participating in the Pediatric Acute Care Cardiology Collaborative (PAC3) were also surveyed on ACU organizational factors and practice patterns. Results Overall, 19,674 hospitalizations across 27 hospitals were included. There was significant variation in ICU and ACU LOS. Post-operative LOS appeared to be most closely related to ICU LOS; 75% (6/8) of hospitals with shorter-than-expected post-operative LOS also had shorter-than-expected ICU LOS. A clear relationship between post-operative and ACU LOS was not observed. Hospitals with an ACU able to provide higher acuity care as indexed according to the PAC3 survey were more likely to have shorter post-operative LOS (p Conclusions For hospitals that achieve shorter-than-expected post-operative LOS following congenital heart surgery, ICU LOS appears to be the primary driver. Higher acuity resources in the ACU may be an important factor facilitating earlier transfer from the ICU. These data are key to informing quality improvement initiatives geared toward reducing post-operative LOS.