Abstract/Details

Exploring race/ethnicity as a risk factor for mortality in newborns following congenital heart surgery at a center of excellence


2010 2010

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Abstract (summary)

The purpose of this study was to determine if race/ethnicity was a significant risk factor for hospital mortality in children following congenital heart surgery in a contemporary sample of newborns with congenital heart disease. Unlike previous studies that utilized administrative databases, this study utilized clinical data collected at the point of care to examine racial/ethnic outcome differences in the context of the patients' clinical condition and their overall perioperative experience. A retrospective cohort design was used. The study sample consisted of 316 newborns (<31 days of age) who underwent congenital heart surgery between January 2007 through December 2009. A multivariate logistic regression model was used to determine the impact of race/ethnicity, insurance status, presence of a spatial anomaly, prenatal diagnosis, postoperative sepsis, cardiac arrest, respiratory failure, unplanned reoperation, and total length of stay in the intensive care unit on outcomes following congenital heart surgery in newborns. The study findings showed that the strongest predictors of hospital mortality following congenital heart surgery in this cohort were postoperative cardiac arrest, postoperative respiratory failure, having a spatial anomaly, and total ICU LOS. Race/ethnicity and insurance status were not significant risk factors. The institution where this study was conducted is designated as a center of excellence for congenital heart disease. These centers have state-of-the-art facilities, extensive experience in caring for children with congenital heart disease, and superior outcomes. This study suggests that optimal care delivery for newborns requiring congenital heart surgery at a center of excellence portends exceptional outcomes and this benefit is conferred upon the entire patient population despite the race/ethnicity of the patients. From a public health and health services view, this study also contributes to the overall body of knowledge on racial/ethnic disparities in children with congenital heart defects and puts forward the possibility of a relationship between quality of care and racial/ethnic disparities. Further study is required to examine the impact of race/ethnicity on the long-term outcomes of these children as they encounter the disparate components of the health care delivery system. There is also opportunity to study the role of race/ethnicity on the hospital morbidity in these patients considering current expectations for hospital survival are very high, and much of the current focus for quality improvement rests in minimizing the development of patient morbidities.

Indexing (details)


Subject
Medicine;
Public health
Classification
0564: Medicine
0573: Public health
Identifier / keyword
Health and environmental sciences, Congenital heart disease, Ethnicity, Outcomes, Quality, Race
Title
Exploring race/ethnicity as a risk factor for mortality in newborns following congenital heart surgery at a center of excellence
Author
Carberry, Kathleen Elizabeth
Number of pages
63
Publication year
2010
Degree date
2010
School code
0219
Source
MAI 48/04M, Masters Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781109702859
Advisor
Horwitz, Irwin
Committee member
Fernandez-Esquer, Maria E.
University/institution
The University of Texas School of Public Health
Department
Policy & Community Health
University location
United States -- Texas
Degree
M.P.H.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
1474742
ProQuest document ID
194024690
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/194024690
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