Background:In the area of acute emergency care, the needs of adult congenital heart disease patients (ACHD) are unique and burden on hospital resources are likely substantial. We aim to understand the predictors of increased hospital length of stay (LOS) and impact on hospital resources.

Methods:We evaluated 600 ACHD patients in our adult congenital database. Patients who required emergency admissions between January 2007 and December 2007 were studied from hospital records.

Results:Sixty-eight ACHD patients (11%) required emergency admissions, culminating in a total of 108 admissions. Mean age was 37.6 years (SD 18.0), with a female preponderance (56%). Most were either schooling or working (62%) and were single (62%). Atrial septal defect (24%), ventricular septal defect (19%) and Tetralogy of Fallot (13%) formed the majority of diagnoses, mirroring proportions in our cohort. A third of the admissions were for cardiac reasons including arrhythmia, heart failure, endocarditis, and thromboembolism; remaining two-thirds were for non-cardiac reasons. Mean hospital LOS was 3.1 days (SD 3.7). Those who were older (p=0.02, 95%CI 0.02 -0.108) and neither employed nor schooling (p=0.021, 95%CI 0.255-3.133) had longer LOS. Thromboembolism accounted for longer LOS (p=0.047, 95%CI 0.035-6.141). 33% of the admissions that required interdisciplinary referrals had increased LOS (p<0.001, 95%CI 1.415-4.257), with utilization of non-cardiac investigations (p=0.002). Increased LOS was not associated with adverse clinical outcome (p=0.68).

Conclusion:Older age groups, unemployment and thromboembolic complications were associated with increased LOS. Non-cardiac conditions required interdisciplinary resources and contributed to increased LOS. Understanding their diverse acute needs will improve care and reduce LOS.