Variability in noncardiac surgical procedures in children with congenital heart disease

Abstract

Background The purpose of this study was to examine the volume and variability of non-cardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. Methods Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004–2012 were included. Frequencies of non-cardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a non-cardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. Results 8,857 patients underwent congenital heart surgery during the first year of life, 3,621 (41%) of whom had 13,894 non-cardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4,432; 31.9%) or otolaryngology (4,002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having non-cardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1–3), children in the high-risk group (categories 4–6) were more likely to have general, dental, orthopedic, and thoracic procedures. Conclusions Children with CHD requiring cardiac surgery frequently also undergo non-cardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population.

Overall Hospital Cost Estimates in Children with Congenital Heart Disease: Analysis of the 2012 Kid’s Inpatient Database

“…Management of children with CHD accounts for a significant proportion of healthcare resource utilization in the USA [7]. Due to significant advances made in diagnosis and treatment of children with CHD over the past decades, many of these patients survive and require hospitalizations, not only for cardiac surgical and catheter-based procedures, but also for other surgical or medical reasons [4,11,17].…”

Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease

“…2 Nearly half of children with CHD may require additional non-cardiac surgeries over their lifetime. 3 Children with CHD have a higher risk of postoperative mortality and morbidity following non-cardiac surgery when compared with children without CHD. 4 However, outcomes of children with CHD who undergo laparoscopic surgery, which is a minimally invasive approach, have not been well characterized.…”

Risk associated with anesthesia for noncardiac surgery in children with congenital heart disease

“…Some major procedures (eg, fundoplication, Ladd's procedure for intestinal malrotation) have been demonstrated to contribute to increased risk in children with CHD and clearly the interplay between patient physiology and operative insult contributes to risk. This issue is confounded by variable indications for surgery both between institutions and between children with and without CHD . Notably, the information about the risk status of children who were declined for surgery is missing.…”