Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium

Andrew H. Smith, Division of Cardiac Critical Care Medicine, The Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Fla. Electronic address: asmit356@jhmi.edu.
Andrew Y. Shin, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, Calif.
Sarah Tabbutt, Division of Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital and the University of California San Francisco Medical School, San Francisco, Calif.
Mousumi Banerjee, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich.
Wenying Zhang, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich.
Santiago Borasino, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
Justin J. Elhoff, Sections of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex.
J William Gaynor, Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Nancy S. Ghanayem, Advocate Aurora HealthFollow
Sara K. Pasquali, Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Mich.
James D. St Louis, Section of Pediatric and Congenital Heart Surgery, Medical College of Georgia, Augusta, Ga.
Subhadra Shashidharan, Department of Surgery, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, Ga.
Michael Ruppe, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Norton Healthcare, University of Louisville School of Medicine, Louisville, Ky.
Kurt R. Schumacher, Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Mich.
Michael Gaies, Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Mich.
John M. Costello, Division of Cardiology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC.Follow

Affiliations

Advocate Children's Hospital

Abstract

Objective: The optimal timing for neonatal cardiac surgery is a potentially modifiable factor that may affect outcomes. We studied the relationship between age at surgery (AAS) and outcomes across multiple hospitals, focusing on neonatal operations where timing appears is not emergency.

Methods: We studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital on or before day of life 2 undergoing selected index cardiac operations. The impact of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup (ie, free of preoperative mechanical ventilation, mechanical circulatory support, or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic complication), and postoperative cardiac intensive care unit and hospital length of stay. Post hoc analyses focused on operations undertaken between day of life 2 and 7.

Results: We studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not associated with risk adjusted mortality or major morbidity among the entire cohort and the standard risk subgroup. Older AAS, although associated with modest increases in postoperative cardiac intensive care unit and hospital length of stay in the entire cohort, was not associated with hospital length of stay in the standard risk subgroup.

Conclusions: Among select nonemergency neonatal cardiac operations, AAS between day of life 2 and 7 was not found to be associated with risk adjusted mortality or major morbidity. Although delays in surgical timing may modestly increase preoperative resource use, studies of AAS and outcomes not evident at the time of discharge are needed.

Document Type

Article

PubMed ID

35760618

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