Timing of neonatal cardiac surgery is not associated with perioperative outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 147; no. 5; pp. 1573 - 1579
• Main Authors: Kumar, T.K. Susheel, MD, Charpie, John R., MD, PhD, Ohye, Richard G., MD, Hirsch-Romano, Jennifer C., MD, Donohue, Janet E., MPH, Yu, Sunkyung, MS, Sood, Vikram, MD, Wilkinson, David A., MD, Nelson, Kathryn, DNP, Mitchell, Elizabeth, MD, Goldberg, Caren S., MD, MSc, Gaies, Michael G., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014
• Subjects: Age Factors; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Early Medical Intervention; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Hospital Mortality; Humans; Infant Mortality; Infant, Newborn; Intensive Care Units, Neonatal; Length of Stay; Multivariate Analysis; Odds Ratio; Postoperative Complications - mortality; Postoperative Complications - therapy; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; stage 1 palliation; S1P; 17; SPS; systemic-to-pulmonary shunt; arterial switch operation; ICU; intensive care unit; ASO; 20
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.07.020

Objective The optimal timing for neonatal cardiac surgery is unknown. We aimed to determine the relationship between age at surgery and perioperative outcomes, hypothesizing that earlier intervention would be associated with lower morbidity and mortality. Methods A retrospective review was performed of neonates who had undergone an arterial switch operation, stage 1 palliation for functional single ventricle, or systemic-to-pulmonary shunt for obstructed pulmonary blood flow from January 1, 2005, to December 31, 2010. The subjects with clinical indications for delayed surgery or prematurity were excluded. Age at surgery was evaluated as both a continuous and a categorical variable. The primary outcome was a composite endpoint of mortality or prolonged intensive care stay. Results Of 344 subjects, 286 (77 arterial switch operation, 124 stage 1 palliation, 85 systemic-to-pulmonary shunt) met the inclusion criteria. In each group, age at surgery was not associated with the primary composite endpoint. The patients who died after systemic-to-pulmonary shunt had a median age at surgery of 3 days versus 6 days for the survivors ( P  = .04). A similar, but nonsignificant, pattern was seen for patients undergoing arterial switch operations (4.5 vs 7 days; P  = .09). Earlier surgery was not associated with a reduced duration of vasoactive support, mechanical ventilation, or intensive care unit length of stay in any group. Stage 1 palliation subjects in the upper age quartile (≥8 days) at surgery were less likely to require prolonged mechanical ventilation ( P  = .03). Conclusions Younger age at intervention in the neonatal period was not associated with reduced morbidity or mortality in any procedural subgroup studied. In our cohort, earlier systemic-to-pulmonary shunt for obstructed pulmonary blood flow was associated with a greater likelihood of a poor outcome.