Table 1.
Baseline Characteristics by Operation
| TOF | CAVSD | ASO | Arch/VSD | Norwood* | |
|---|---|---|---|---|---|
| Total N | 250 | 249 | 251 | 150 | 249 |
| Age at surgery (days), median (25th,75th) | 150 (99, 188) | 141 (105, 179) | 6 (4, 8) | 8 (5, 15) | 5 (4, 7) |
| Weight (kilogram), median (25th,75th) | 6.2 (5.3, 7.2) | 5.2 (4.4, 5.8) | 3.4 (3.1, 3.8) | 3.3 (3.0, 3.8) | 3.3 (2.9, 3.6) |
| Male Gender | 144 (58%) | 109 (44%) | 185 (74%) | 83 (55%) | 159 (64%) |
| Race | |||||
| White/Caucasian | 166 (66%) | 157 (63%) | 170 (68%) | 107 (71%) | 186 (75%) |
| Black/African American | 24 (10%) | 41 (17%) | 13 (5%) | 9 (6%) | 27 (11%) |
| Other Race | 25 (10%) | 18 (7%) | 24 (10%) | 14 (9%) | 20 (8%) |
| Unknown or Not Reported | 35 (14%) | 33 (13%) | 44 (18%) | 20 (13%) | 16 (6%) |
| Ethnicity | |||||
| Hispanic/Latino | 27 (11%) | 28 (11%) | 28 (11%) | 26 (17%) | 23 (9%) |
| Not Hispanic/Latino | 191 (76%) | 190 (76%) | 183 (73%) | 110 (73%) | 209 (84%) |
| Unknown | 32 (13%) | 31 (12%) | 40 (16%) | 14 (9%) | 17 (7%) |
| Pregnancy term | |||||
| Full term | 216 (86%) | 212 (85%) | 234 (93%) | 139 (93%) | 237 (95%) |
| Pre-term | 26 (10%) | 32 (13%) | 17 (7%) | 11 (7%) | 12 (5%) |
| Unknown | 8 (3%) | 5 (2%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Antenatal diagnosis of CHD | |||||
| No | 120 (48%) | 66 (27%) | 96 (38%) | 81 (54%) | 35 (14%) |
| Yes | 118 (47%) | 171 (69%) | 155 (62%) | 68 (45%) | 213 (86%) |
| Unknown | 12 (5%) | 12 (5%) | 0 (0%) | 1 (1%) | 1 (0%) |
| Non cardiac congenital anomaly, syndromes, genetic abnormalities †,‡ | |||||
| 0 | 204 (82%) | 33 (13%) | 238 (95%) | 108 (72%) | 208 (84%) |
| 1 | 32 (13%) | 185 (74%) | 8 (3%) | 28 (19%) | 33 (13%) |
| >1 | 14 (6%) | 31 (12%) | 5 (2%) | 14 (9%) | 8 (3%) |
| Timing of Surgery § | |||||
| Elective | 218 (87%) | 216 (87%) | 90 (36%) | 75 (50%) | 100 (40%) |
| Urgent | 31 (12%) | 33 (13%) | 152 (61%) | 74 (49%) | 142 (57%) |
| Emergent | 1 (0%) | 0 (0%) | 9 (4%) | 1 (1%) | 7 (3%) |
| Pre-operative risk factor †,║ | |||||
| 0 | 206 (82%) | 162 (65%) | 130 (52%) | 92 (61%) | 168 (68%) |
| 1 | 39 (16%) | 67 (27%) | 82 (33%) | 34 (23%) | 54 (22%) |
| >1 | 5 (2%) | 20 (8%) | 39 (16%) | 24 (16%) | 27 (11%) |
| Procedure-specific factor †,# | |||||
| 0 | 154 (62%) | 186 (75%) | 51 (20%) | 38 (25%) | 52 (21%) |
| 1 | 79 (32%) | 48 (19%) | 54 (22%) | 56 (37%) | 104 (42%) |
| >1 | 17 (7%) | 15 (6%) | 146 (58.2%) | 56 (37%) | 93 (37%) |
| Institutional practice to discharge directly from ICU | 26 (10%) | 11 (4%) | 41 (16.3%) | 16 (11%) | 34 (14%) |
| Tertiles of site volume | |||||
| 13 – 29 | 23 (9%) | 19 (8%) | 22 (8.8%) | 6 (4%) | 25 (10%) |
| 40 – 82 | 86 (34%) | 69 (28%) | 89 (35.5%) | 46 (31%) | 80 (32%) |
| 89 – 153 | 141 (56%) | 161 (65%) | 140 (55.8%) | 98 (65%) | 144 (58%) |
| Categories of surgeon volume | |||||
| 1 – 10 | 27 (11%) | 17 (7%) | 25 (10.0%) | 13 (9%) | 27 (11%) |
| 11 – 28 | 103 (41%) | 95 (38%) | 115 (45.8%) | 50 (33%) | 100 (40%) |
| 30 – 43 | 120 (48%) | 137 (55%) | 111 (44.2%) | 87 (58%) | 122 (49%) |
| Intraoperative findings different from preoperative echocardiogram ** | |||||
| No | 225 (90%) | 224 (90%) | 212 (84.5%) | 133 (89%) | 236 (95%) |
| Yes, better | 3 (1%) | 1 (0%) | 4 (1.6%) | 4 (3%) | 0 (0%) |
| Yes, worse | 22 (9%) | 24 (10%) | 35 (13.9%) | 13 (9%) | 13 (5%) |
N (%), unless otherwise specified
ventricular dominance:83% RV dominant, 8% LV dominant, 5% balanced, 4% indeterminate; single ventricle anatomy: 30% AA/MA, 25% AA/MS, 6% AS/MA, 20% AS/MS, 19% other
outcome modelling compared between 3-categories (0,1,>1) and 2-categories (yes/no); the more significantly associated grouping was chosen for multivariable modelling
non-cardiac congenital abnormalities, genetic defects, and syndromes combined as a single category
emergent combined with urgent in outcome modelling due to low N. Choice for elective neonatal surgery (ASO, Arch/VSD, Norwood) was site-dependent with some sites selecting “Elective” for neonatal surgery for index operations performed after postnatal stabilization as a scheduled case, rather than as an urgent or emergent case for hemodynamic instability.
CPR, AV block, mechanical support, shock (persistent or resolved at time of surgery), mechanical ventilator support up to surgery, renal failure, hepatic failure, neurologic deficit, sepsis, NEC, noncardiac surgery, tracheostomy, other preoperative risk factors (e.g., coagulation disorder, respiratory syncytial virus)
see Nathan, et. al.25 for a list for each surgery
“yes, better” combined with “no” in outcome modelling due to low N
AA = aortic atresia; Arch/VSD = coarctation/hypoplastic or interrupted arch with VSD; AS = aortic stenosis; ASO = arterial switch operation; AV = atrioventricular block; CAVSD = complete atrioventricular septal defect; CHD = congenital heart disease; CPR = cardio pulmonary resuscitation; ICU = intensive care unit; MA = mitral atresia; MS = mitral stenosis; N = number; NEC=necrotizing enterocolitis; TOF = tetralogy of Fallot with pulmonary stenosis