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Variability in noncardiac surgical procedures in children with congenital heart disease
Jason P Sulkowski1, Jennifer N Cooper2, Patrick I McConnell3
1Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Children with congenital heart disease (CHD) often need noncardiac surgeries. There
Area of Science:
- Pediatric Surgery
- Congenital Heart Disease (CHD)
- Health Services Research
Background:
- Children with congenital heart disease (CHD) requiring cardiac surgery in their first year of life often face complex medical needs.
- The frequency and types of noncardiac surgical procedures in this vulnerable population are not well-characterized.
Purpose of the Study:
- To investigate the volume and variability of noncardiac surgeries performed in infants with CHD who require cardiac surgery.
- To analyze the types of noncardiac procedures and identify factors associated with their occurrence.
Main Methods:
- Retrospective analysis of 8857 patients undergoing cardiac surgery by age 1, with 5-year follow-up, using the Pediatric Health Information System database (2004-2012).
- Frequencies of noncardiac procedures by age 5 were determined and categorized by subspecialty.
- Patients were stratified by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and hospital variations were assessed using logistic mixed effects models.
Main Results:
- 3621 (41%) of 8857 patients had 13,894 noncardiac procedures by age 5, primarily in general surgery (31.9%) and otolaryngology (28.8%).
- Significant hospital-level variation was observed in the rates of noncardiac procedures among CHD patients.
- High-risk patients (RACHS-1 categories 4-6) were more likely to undergo general, dental, orthopedic, and thoracic procedures compared to low-risk patients (categories 1-3).
Conclusions:
- Children with CHD requiring initial cardiac surgery frequently undergo subsequent noncardiac procedures.
- Substantial variability exists in the frequency of these noncardiac surgeries across different hospitals.
- This variability suggests inconsistent indications for surgical intervention, highlighting the need for standardized care protocols for this complex pediatric population.
Background:
The purpose of this study was to examine the volume and variability of noncardiac 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 and 2012 were included. Frequencies of noncardiac 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 noncardiac surgical procedure for each subspecialty were compared using logistic mixed effects models.
Results:
8857 patients underwent congenital heart surgery during the first year of life, 3621 (41%) of whom had 13,894 noncardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4432; 31.9%) or otolaryngology (4002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having noncardiac 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 noncardiac 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.
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