Relationship Between Gestational Age and Outcomes After Congenital Heart Surgery
Previous studies suggest that birth before 39 weeks’ gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birt...
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Published in | The Annals of thoracic surgery Vol. 112; no. 5; pp. 1509 - 1516 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
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Elsevier Inc
01.11.2021
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Abstract | Previous studies suggest that birth before 39 weeks’ gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on postoperative outcomes using the Pediatric Cardiac Critical Care Consortium (PC4) database.
Infants undergoing selected index cardiac operations before the end of the neonatal period were included (n = 2298). GA at birth and corrected GA at the time of the index cardiac operation were used as categorical predictors and fitted as a cubic spline to assess nonlinear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders.
Late-preterm (34-36 weeks) birth was associated with increased odds of mortality compared with full-term (39-40 weeks) birth, while early-term (37-38 weeks) birth was not associated with increased mortality. Corrected GA at surgery of 34 to 37 weeks compared with 40 to 44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA.
Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC4 hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival. |
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AbstractList | Previous studies suggest that birth before 39 weeks' gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on postoperative outcomes using the Pediatric Cardiac Critical Care Consortium (PC
) database.
Infants undergoing selected index cardiac operations before the end of the neonatal period were included (n = 2298). GA at birth and corrected GA at the time of the index cardiac operation were used as categorical predictors and fitted as a cubic spline to assess nonlinear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders.
Late-preterm (34-36 weeks) birth was associated with increased odds of mortality compared with full-term (39-40 weeks) birth, while early-term (37-38 weeks) birth was not associated with increased mortality. Corrected GA at surgery of 34 to 37 weeks compared with 40 to 44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA.
Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC
hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival. Previous studies suggest that birth before 39 weeks’ gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on postoperative outcomes using the Pediatric Cardiac Critical Care Consortium (PC4) database. Infants undergoing selected index cardiac operations before the end of the neonatal period were included (n = 2298). GA at birth and corrected GA at the time of the index cardiac operation were used as categorical predictors and fitted as a cubic spline to assess nonlinear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders. Late-preterm (34-36 weeks) birth was associated with increased odds of mortality compared with full-term (39-40 weeks) birth, while early-term (37-38 weeks) birth was not associated with increased mortality. Corrected GA at surgery of 34 to 37 weeks compared with 40 to 44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA. Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC4 hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival. BACKGROUNDPrevious studies suggest that birth before 39 weeks' gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on postoperative outcomes using the Pediatric Cardiac Critical Care Consortium (PC4) database. METHODSInfants undergoing selected index cardiac operations before the end of the neonatal period were included (n = 2298). GA at birth and corrected GA at the time of the index cardiac operation were used as categorical predictors and fitted as a cubic spline to assess nonlinear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders. RESULTSLate-preterm (34-36 weeks) birth was associated with increased odds of mortality compared with full-term (39-40 weeks) birth, while early-term (37-38 weeks) birth was not associated with increased mortality. Corrected GA at surgery of 34 to 37 weeks compared with 40 to 44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA. CONCLUSIONSContrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC4 hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival. |
Author | Gaies, Michael Werho, David K. Lasa, Javier J. Axelrod, David Guffey, Danielle Yeh, Justin Savorgnan, Fabio Shekerdemian, Lara Elhoff, Justin J. Tweddell, James S. Steurer, Martina A. Ghanayem, Nancy S. Buckley, Jason R. |
AuthorAffiliation | 4 University of Michigan, Ann Arbor, MI 8 University of California-San Francisco, CA 3 Medical University of South Carolina, Charleston, SC 5 University of Cincinnati, Cincinnati, OH 2 Stanford University, Palo Alto, CA 7 University of Pittsburgh, Pittsburgh, PA 1 Baylor College of Medicine, Houston, TX 6 University of California-San Diego, San Diego, CA |
AuthorAffiliation_xml | – name: 8 University of California-San Francisco, CA – name: 7 University of Pittsburgh, Pittsburgh, PA – name: 6 University of California-San Diego, San Diego, CA – name: 3 Medical University of South Carolina, Charleston, SC – name: 1 Baylor College of Medicine, Houston, TX – name: 4 University of Michigan, Ann Arbor, MI – name: 2 Stanford University, Palo Alto, CA – name: 5 University of Cincinnati, Cincinnati, OH |
Author_xml | – sequence: 1 givenname: Fabio surname: Savorgnan fullname: Savorgnan, Fabio organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 2 givenname: Justin J. surname: Elhoff fullname: Elhoff, Justin J. email: jxelhoff@texaschildrens.org organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 3 givenname: Danielle surname: Guffey fullname: Guffey, Danielle organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 4 givenname: David surname: Axelrod fullname: Axelrod, David organization: Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas – sequence: 5 givenname: Jason R. surname: Buckley fullname: Buckley, Jason R. organization: Department of Pediatrics, Stanford University, Palo Alto, California – sequence: 6 givenname: Michael surname: Gaies fullname: Gaies, Michael organization: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina – sequence: 7 givenname: Nancy S. surname: Ghanayem fullname: Ghanayem, Nancy S. organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 8 givenname: Javier J. surname: Lasa fullname: Lasa, Javier J. organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 9 givenname: Lara surname: Shekerdemian fullname: Shekerdemian, Lara organization: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas – sequence: 10 givenname: James S. surname: Tweddell fullname: Tweddell, James S. organization: Department of Pediatrics, University of Michigan, Ann Arbor, Michigan – sequence: 11 givenname: David K. surname: Werho fullname: Werho, David K. organization: Department of Surgery, University of Cincinnati, Cincinnati, Ohio – sequence: 12 givenname: Justin surname: Yeh fullname: Yeh, Justin organization: Department of Pediatrics, University of California-San Diego, San Diego, California – sequence: 13 givenname: Martina A. surname: Steurer fullname: Steurer, Martina A. organization: Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania |
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CitedBy_id | crossref_primary_10_1016_j_jpeds_2022_11_033 crossref_primary_10_1017_S1047951123002950 crossref_primary_10_1111_apa_16155 crossref_primary_10_1007_s40746_022_00235_0 crossref_primary_10_1111_ppe_12959 crossref_primary_10_1542_neo_23_6_e373 crossref_primary_10_1542_peds_2022_056415D crossref_primary_10_1016_j_athoracsur_2020_10_039 crossref_primary_10_1016_j_jtcvs_2022_05_029 crossref_primary_10_1016_j_jtcvs_2022_06_013 crossref_primary_10_1186_s40001_024_01735_5 |
Cites_doi | 10.1053/pcsu.2001.24985 10.1016/j.ejcts.2004.04.004 10.1007/s00246-019-02191-3 10.1161/CIRCULATIONAHA.113.005864 10.1161/01.cir.0000437597.44550.5d 10.1510/icvts.2010.253823 10.1542/peds.2006-0018 10.1161/CIRCULATIONAHA.112.001089 10.1016/j.jpeds.2005.10.034 10.1056/NEJMoa067393 10.1097/01.AOG.0000437385.88715.4a 10.1053/j.pcsu.2013.01.004 10.1016/j.athoracsur.2003.12.066 10.1017/S1047951115001833 10.1016/j.jpeds.2011.04.020 10.1542/peds.2017-0999 10.1016/j.jtcvs.2011.09.008 |
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Snippet | Previous studies suggest that birth before 39 weeks’ gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital... Previous studies suggest that birth before 39 weeks' gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital... BACKGROUNDPrevious studies suggest that birth before 39 weeks' gestational age (GA) is associated with higher perioperative mortality and morbidity after... |
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Title | Relationship Between Gestational Age and Outcomes After Congenital Heart Surgery |
URI | https://dx.doi.org/10.1016/j.athoracsur.2020.08.027 https://www.ncbi.nlm.nih.gov/pubmed/33080235 https://search.proquest.com/docview/2452981608 https://pubmed.ncbi.nlm.nih.gov/PMC8052379 |
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