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Preoperative in-hospital mortality in neonates with critical CHD

Published online by Cambridge University Press:  28 December 2021

Dennis R. Delany Open the ORCID record for Dennis R. Delany [Opens in a new window] ,
Shahryar M. Chowdhury Open the ORCID record for Shahryar M. Chowdhury [Opens in a new window] ,
Corinne Corrigan  and
Jason R. Buckley
Dennis R. Delany*
Affiliation:
Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Shahryar M. Chowdhury
Affiliation:
Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Corinne Corrigan
Affiliation:
Quality Management, Medical University of South Carolina, Charleston, SC, USA
Jason R. Buckley
Affiliation:
Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
*
Author for correspondence: D. R. Delany, MD, 1800 Orleans Street, Bloomberg 6331, Baltimore, MD 21287, USA. Tel: 1-410-287-5300; Fax: 1-410-367-2232. E-mail: ddelany1@jhu.edu
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Abstract

Objective:

Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres.

Study design:

The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation.

Results:

Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor.

Conclusion:

Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

Keywords

Critical carepaediatric cardiologyPHIS
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 11 , November 2022 , pp. 1794 - 1800
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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