Authors: Erin A Paul Kristina Orfali Thomas J Starc
Publish Date: 2016/08/27
Volume: 37, Issue: 8, Pages: 1446-1452
Abstract
We hypothesized that enthusiasm for surgery increased for infants with hypoplastic left heart syndrome HLHS at Columbia University Medical Center CUMC between 1995 and 2012 We sought to identify factors that engendered this paradigm shift Confidential surveys were distributed to providers at CUMC in 1995 and 2012 to measure enthusiasm for surgical intervention for HLHS Surgical preference scores are presented as median interquartile range Surveys were completed by 99/176 providers 56 response rate in 1995 and 153/267 57 in 2012 The median surgical preference score for infants with HLHS increased from 35 25–45 in 1995 to 45 35–50 in 2012 P 0001 53 95 CI 42 64 of respondents recommended surgical intervention for a ward of the court in 1995 compared to 81 73 89 in 2012 P 0001 In 2012 64 53 75 of respondents were more likely to recommend surgery than 10 years prior The percentage of respondents who saw good outcomes following threestage repair increased from 49 38 60 in 1995 to 84 78 90 in 2012 P 0001 The majority believed that parents should have the option of comfort care 91 85 97 in 1995 and 85 79 91 in 2012 P = 006 In both eras prematurity and additional surgical problems dissuaded providers from recommending surgical intervention Despite the fact that most providers have seen good outcomes and now recommend surgery for infants with HLHS the majority of providers still believe that the option of comfort care should be available to familiesAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards For this type of study formal consent is not required This article does not contain any studies with animals performed by any of the authors
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