Author + information
- Received September 14, 2018
- Revision received December 4, 2018
- Accepted January 3, 2019
- Published online April 10, 2019.
- Michael L. O’Byrne, MD, MSCEa,b,c,∗ (, )
- Marisa E. Millenson, MSa,
- James M. Steven, MDd,
- Matthew J. Gillespie, MDa,
- Yoav Dori, MD, PhDa,
- Andrew C. Glatz, MD, MSCEa,b and
- Jonathan J. Rome, MDa
- aDivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- bCenter for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cLeonard Davis Institute and Center for Cardiovascular Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania
- dDepartment of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia and Department of Anesthesia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Michael L. O’Byrne, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
Objectives The purpose of this study was to evaluate the association between the method of procedural sedation and outcomes for congenital cardiac catheterization procedures.
Background The safety of operator-directed sedation (ODS) in the pediatric/congenital cardiac catheterization laboratory has been questioned. To our knowledge, the relative safety of ODS versus general anesthesia (GA) in these cases has not to date been critically evaluated.
Methods A single-center retrospective cohort study was performed to compare the relative safety, cost, and times of catheterization procedures performed with ODS and those performed with GA from a cardiac anesthesiologist. The risk of adverse outcomes was compared using propensity-score-adjusted models. Using the same propensity score, procedure times and relative charges were also compared.
Results Over the study period, 4,424 procedures in 2,547 patients were studied. Of these, 27% of cases were performed with ODS. ODS procedures were 70% diagnostic procedures, 17% device closure of patent ductus arteriosus, 5% balloon pulmonary valvuloplasty, and 3% pulmonary artery angioplasty. The risk of adverse event in adjusted models for ODS cases was significantly lower than in GA cases (odds ratio: 0.66; 95% confidence interval: 0.45 to 0.95; p = 0.03). Total room time and case time were also significantly shorter (p < 0.001). Professional (charge ratio: 0.88; p < 0.001) and hospital (charge ratio: 0.84; p < 0.001) charges for ODS cases were also lower than those for GA cases.
Conclusions This study demonstrates that clinical judgment can identify subjects in whom ODS is not associated with increased risk of adverse events. The use of ODS was associated with reduced case times and charges. In combination, these findings suggest that the selective use of ODS can allow for greater efficiency and higher value care without sacrificing safety.
The funding agencies had no role in the planning or execution of the study, nor did they edit the manuscript as presented. The manuscript represents the opinions of the authors alone. Dr. O’Byrne receives research support from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23 HL130420-01). Dr. Gillespie is a consultant and primary investigator for Medtronic and W.L. Gore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 14, 2018.
- Revision received December 4, 2018.
- Accepted January 3, 2019.
- 2019 American College of Cardiology Foundation
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