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Morbidity During Adult Congenital Heart Surgery Admissions

  • Matan Setton
  • Wei He
  • Oscar J. BenavidezEmail author
Original Article

Abstract

The frequency of complications during Adult Congenital Heart Disease (ACHD) surgery admissions and their association to patient outcome is not well known. Our study objectives are to (1) define the frequency of complications during ACHD surgery admissions, (2) identify their risk factors, and (3) explore their association with death and resource use. We identified ACHD surgery admissions ages 18 to 49 during the years 2005–2009 from the Nationwide Inpatient Sample database. Complications were defined according to the Society of Thoracic Surgeons Short List of Complications for congenital heart surgery. We identified 16,841 ACHD surgery admissions, of which 46.9% had at least one complication. Cardiac (19.4%), respiratory (18.2%), infectious (14.1%), and acute kidney injury (6.8%) were the most common. Admissions with a complication had a longer length of stay (10 days vs. 5 days; p < 0.001), increased charges ($139,522 vs. $84,672; p < 0.001), and higher mortality (4.6% vs. 0.9%; p < 0.001). Adjusted risk factors for complications included non-White race (AOR 1.17, p = 0.003), government insurance AOR 1.39, high surgical complexity RACHS-1 category 3 + AOR 1.81, non-elective admission OR 2.18, chronic kidney disease AOR 2.79, chronic liver disease AOR 2.47, and CHF AOR 1.40; all p < 0.001. Complications were independently associated with death AOR 2.49, p < 0.001. Complications occur frequently during ACHD surgery admissions and are associated with increased resource use and are a risk factor for death. Identification of preventable morbidity may improve the outcomes of these complex patients.

Keywords

Congenital heart surgery Quality Outcomes Complications 

Notes

Author Contributions

MS: Background data collection, manuscript writing, and developing analytic plan; WH: Biostatistics; OB: Hypothesis development, analytic plan development, and manuscript finalization.

Funding

The authors have no financial relationships relevant to this article to disclose.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Pillutla P, Shetty KD, Foster E (2009) Mortality associated with adult congenital heart disease: trends in the us population from 1979 to 2005. Am Heart J 158:874–879CrossRefGoogle Scholar
  2. 2.
    Opotowsky AR, Siddiqi OK, Webb GD (2009) Trends in hospitalizations for adults with congenital heart disease in the US. J Am Coll Cardiol 54:460–467CrossRefGoogle Scholar
  3. 3.
    Benavidez OJ, Gauvreau K, Bacha E, Del Nido P, Jenkins KJ (2008) Application of a complication screening method to congenital heart surgery admissions: a preliminary report. Pediatr Cardiol 29:258–265CrossRefGoogle Scholar
  4. 4.
    Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Risk factors for death after adult congenital heart surgery in pediatric hospitals. Circ Cardiovasc Qual Outcomes 4:433–439CrossRefGoogle Scholar
  5. 5.
    Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefGoogle Scholar
  6. 6.
    Kogon BE, Plattner C, Leong T, Kirshbom PM, Kanter KR, McConnell M, Book W (2009) Adult congenital heart surgery: adult or pediatric facility? Adult or pediatric surgeon? Ann Thorac Surg 87:833–840CrossRefGoogle Scholar
  7. 7.
    Kogon B, Grudziak J, Sahu A, Jokhadar M, McConnell M, Book W, Oster M (2013) Surgery in adults with congenital heart disease: risk factors for morbidity and mortality. Ann Thorac Surg 95:1377–1382CrossRefGoogle Scholar
  8. 8.
    Jacobs JP, Benavidez OJ, Bacha EA, Walters HL, Jacobs ML (2008) The nomenclature of safety and quality of care for patients with congenital cardiac disease: a report of the society of thoracic surgeons congenital database taskforce subcommittee on patient safety. Cardiol Young 18(Suppl 2):81–91CrossRefGoogle Scholar
  9. 9.
    Jacobs JP (2008) Introduction–databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease. Cardiol Young 18(Suppl 2):1–37Google Scholar
  10. 10.
    Benavidez OJ, Gauvreau K, Del Nido P, Bacha E, Jenkins KJ (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84:147–155CrossRefGoogle Scholar
  11. 11.
    Vida VL, Berggren H, Brawn WJ, Daenen W, Di Carlo D, Di Donato R, Lindberg HL, Corno AF, Fragata J, Elliott MJ, Hraska V, Kiraly L, Lacour-Gayet F, Maruszewski B, Rubay J, Sairanen H, Sarris G, Urban A, Van Doorn C, Ziemer G, Stellin G (2007) Risk of surgery for congenital heart disease in the adult: a multicentered european study. Ann Thorac Surg 83:161–168CrossRefGoogle Scholar
  12. 12.
    Padalino MA, Speggiorin S, Rizzoli G, Crupi G, Vida VL, Bernabei M, Gargiulo G, Giamberti A, Santoro F, Vosa C, Pacileo G, Calabrò R, Daliento L, Stellin G (2007) Midterm results of surgical intervention for congenital heart disease in adults: an italian multicenter study. J Thorac Cardiovasc Surg 134(106–113):113.e101–113.e109Google Scholar
  13. 13.
    Mascio CE, Pasquali SK, Jacobs JP, Jacobs ML, Austin EH (2011) Outcomes in adult congenital heart surgery: analysis of the society of thoracic surgeons database. J Thorac Cardiovasc Surg 142:1090–1097CrossRefGoogle Scholar
  14. 14.
    Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Resource use among adult congenital heart surgery admissions in pediatric hospitals: risk factors for high resource utilization and association with inpatient death. Circ Cardiovasc Qual Outcomes 4:634–639CrossRefGoogle Scholar
  15. 15.
    Valente AM, Lewis M, Vaziri SM, Bautista-Hernandez V, Harmon A, Kim Y, Wu FM, Joyce C, Loyola H, Mayer JE, Bacha E, Landzberg MJ (2013) Outcomes of adolescents and adults undergoing primary fontan procedure. Am J Cardiol 112:1938–1942CrossRefGoogle Scholar
  16. 16.
    Benavidez OJ, Gauvreau K, Geva T (2014) Diagnostic errors in congenital echocardiography: importance of study conditions. J Am Soc Echocardiogr 27:616–623CrossRefGoogle Scholar
  17. 17.
    Bhatt AB, Rajabali A, He W, Benavidez OJ (2015) High resource use among adult congenital heart surgery admissions in adult hospitals: risk factors and association with death and comorbidities. Congenit Heart Dis 10:13–20CrossRefGoogle Scholar
  18. 18.
    Benavidez OJ, Gauvreau K, Jenkins KJ (2006) Racial and ethnic disparities in mortality following congenital heart surgery. Pediatr Cardiol 27:321–328CrossRefGoogle Scholar
  19. 19.
    Putman LM, van Gameren M, Meijboom FJ, de Jong PL, Roos-Hesselink JW, Witsenburg M, Takkenberg JJ, Bogers AJ (2009) Seventeen years of adult congenital heart surgery: a single centre experience. Eur J Cardiothorac Surg 36:96–104 discussion 104 CrossRefGoogle Scholar
  20. 20.
    Holst KA, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Li Z, Schaff HV (2011) Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg 92:122–128 discussion 129–130 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric-Congenital Cardiology, Department of PediatricMassGeneral Hospital for Children, Massachusetts General Hospital, Harvard Medical SchoolBostonUSA

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