| Institution: | 1. Department of Cardiac Surgery, Boston Children''s Hospital, Boston, Mass;2. Department of Cardiology, Boston Children''s Hospital, Boston, Mass;3. Department of Biostatistics, Harvard School of Public Health, Boston, Mass;4. Department of Surgery, Harvard Medical School, Boston, Mass;1. Department of Cardiothoracic Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Heart Research Group, Murdoch Children''s Research Institute, Melbourne, Australia;4. Department of Cardiology, Royal Children''s Hospital, Melbourne, Australia;5. Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md;2. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md;4. Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Md;5. Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Md;6. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;7. Adventist Healthcare White Oak Medical Center, Silver Spring, Md;1. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts;2. Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts;3. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts;4. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;5. Department of Surgery, Harvard Medical School, Boston, Massachusetts;1. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;2. Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan;3. Department of Pediatrics, National Taiwan University Children''s Hospital, Taipei, Taiwan;4. Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan;1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa;2. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa;1. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA;2. Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA;3. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA;4. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA;5. Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA |
| Abstract: | ObjectiveOutcomes after first-stage palliation of single-ventricle heart disease are influenced by many factors, including the presence of residual lesions requiring reintervention. However, there is a dearth of information regarding the optimal timing of reintervention. We assessed if earlier reintervention would be favorably associated with in-hospital outcomes among patients requiring unplanned reinterventions after the Norwood operation.MethodsThis was a single-center, retrospective review of all patients who underwent the Norwood procedure from January 1997 to November 2017 and required a predischarge unplanned surgical or transcatheter reintervention on 1 or more subcomponent areas repaired at the index operation. Outcomes of interest included in-hospital mortality or transplant, postoperative hospital length of stay, and inpatient cost. Associations between timing of reintervention and outcomes were assessed using logistic regression (mortality or transplant) or generalized linear models (postoperative hospital length of stay and cost), adjusting for baseline patient-related and procedural factors.ResultsOf 500 patients who underwent the Norwood operation, 92 (18.4%) required an unplanned reintervention. Median time to reintervention was 12 days (interquartile range, 5-35 days). There were 31 (33.7%) deaths or transplants, median postoperative hospital length of stay was 49 days (interquartile range, 32-87 days), and median cost was $328,000 (interquartile range, $204,000-$464,000). On multivariable analysis, each 5-day increase in time to reintervention increased the odds of mortality or transplant by 20% (odds ratio, 1.2; 95% confidence interval, 1.1-1.3; P = .004). Longer time to reintervention was also significantly associated with greater postoperative hospital length of stay (P < .001) and higher cost (P < .001).ConclusionsFor patients requiring predischarge unplanned reinterventions after the Norwood operation, earlier reintervention is associated with improved in-hospital transplant-free survival and resource use. |
