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Risk Factors for Death After Adult Congenital Heart Surgery in Pediatric Hospitals
YY Kim, K Gauvreau, EA Bacha... - ... Quality and Outcomes, 2011 - Am Heart Assoc From the Divisions of Cardiology (YYK), Hospital of the University of Pennsylvania and Children's
Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA; the
Department of Cardiology (KG, MJL, OJB), Children's Hospital Boston, Harvard Medical ...
Methods and Results We obtained inpatient data from 42 free-standing pediatric hospitals using the Pediatric Health Information System data base 2000 to 2008 and selected ACH surgery admissions (ages 18 to 49 years). We examined admission characteristics and hospital surgery volume. Of 97 563 total (pediatric and adult) congenital heart surgery admissions, 3061 (3.1%) were ACH surgery admissions. Median adult age was 22 years and 39% were between ages 25 to 49 years. Most frequent surgical procedures were pulmonary valve replacement, secundum atrial septal defect repair, and aortic valve replacement. Adult mortality rate was 2.2% at discharge. Multivariable analyses identified the following risk factors for death: age 25 to 34 years (adjusted odds ratio [AOR], 2.1; P=0.009), age 35 to 49 years (AOR, 3.2; P=0.001), male sex (AOR, 1.8; P=0.04), government-sponsored insurance (AOR, 1.8; P=0.03), and higher surgical risk categories 4+ (AOR, 21.5; P=0.001). After adjusting for case mix, pediatric hospitals with high ACH surgery volume had reduced odds for death (AOR, 0.4; P=0.003). There was no relationship between total congenital heart surgery volume and ACH inpatient mortality.
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Risk Factors for Death After Adult Congenital Heart Surgery in Pediatric Hospitals |
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