Outcomes differ in patients who undergo immediate intraoperative revision versus patients with delayed postoperative revision of residual lesions in congenital heart operations
Open accessAbstract
Objectives In a previous study of infants less than 6 month old, we found that delayed revision of residual lesions resulted in worse patient outcomes compared with intraoperative revision. We explored a larger cohort to determine if this finding persisted.Methods A prospective cohort followed from index surgery to discharge from January 2011 to September 2013 were divided into 4 groups: (1) intraoperative revisions (IO) of residual lesions, (2) delayed postoperative revision (PO) of residual lesions during the same hospital stay, (3) both intraoperative and delayed (BOTH) revision of residual lesions, (4) no intraoperative or postoperative revision (NO). Linear and logistic regression analyses were used to compare outcomes of postoperative hospital length of stay, postoperative adverse events (AE), hospital costs, and mortality, after adjusting for age, prematurity, presence of extracardiac anomalies, and RACHS-1 (Risk Adjustment for Congenital Heart Surgery-1) risk category known to affect outcomes.Results Of the 2427 patients discharged after a congenital cardiac operation, 1886 were eligible for this study after exclusion of adults, procedures performed off cardiopulmonary bypass, and transplants and assist devices. On multivariable modeling adjusting for other significant patient factors, the NO group fared better than the other 3 groups. The IO group had significantly lower postoperative length of stay, AE rate, and hospital costs compared with the PO and BOTH groups, but showed no significant differences in mortality.Conclusions Intraoperative correction of residual lesions results in shorter length of stay, and lower postoperative AE and costs compared with delayed postoperative revision of residual lesions.
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Few data have been published on intraoperative echocardiography for Stage 1 Norwood palliation.
“Little data on intraoperative echo for S1NP has been published.”
From Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al. (2017) · cites this paper as [21]
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References 32 · Cited by 18
Research works printed but not linked: 1
- Nathan M, Karamichalis J, Liu H, del Nido P, Pigula F, Thiagarajan R, et al. Intra- operative adverse events can be compensated in infants after cardiac surgery: a prospective study. J Thorac Cardiovasc Surg. 2011;142:1098-107.
- Authors
- Nathan, M., Gauvreau, K., Liu, H., Pigula, F. A., Mayer, J. E., Colan, S. D., & del Nido, P. J.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Nathan, Meena
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 148
- Issue
- 6
- Pages
- 2540-2547.e5
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2048645496
- Cited by
- 18
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 1 · 2014: 1
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- congenital heart surgery, postoperative hospital stay, postoperative complications, hospital costs, mortality, infants
- MeSH terms
- Adolescent, Child, Child, Preschool, Cost-Benefit Analysis, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Length of Stay, Male, Postoperative Complications, Prospective Studies, Reoperation, Risk Factors, Time Factors, Multivariate Analysis, Chi-Square Distribution, Linear Models, Logistic Models, Odds Ratio, Treatment Outcome, Cost Savings, Hospital Costs, Time-to-Treatment
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