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Outcomes Following Norwood Procedures: Analysis of a "Small Volume" Program
John D'Angelo1, Sukumar Suguna Narasimhulu1,2, Kamal Pourmoghadam1,2
1124506University of Central Florida College of Medicine, Orlando, FL, USA.
Summary
Small-volume centers can achieve survival outcomes for Norwood procedures comparable to large-volume centers. Key factors influencing success are achievable with adequate resource allocation, challenging traditional volume-outcome correlations.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Outcomes
- Surgical Volume-Outcome Relationship
Background:
- Institutional survival after Norwood procedures is typically linked to surgical volume.
- Studies at high-volume centers show improved Norwood procedure survival.
- This study examines outcomes at a small-volume institution.
Purpose of the Study:
- To report short- and long-term outcomes of Norwood procedures at a single, small-volume institution.
- To identify factors influencing outcomes in this setting.
- To compare outcomes with those from large-volume centers.
Main Methods:
- Retrospective analysis of 113 patients undergoing Norwood procedures (2005-2020).
- Kaplan-Meier survival analysis and Cox regression for risk factors.
- First interstage risk factor scoring to compare observed vs. expected survival.
Main Results:
- 1, 5, and 10-year survival (death or transplant) were 88%, 80%, and 76%.
- 1, 5, and 10-year survival post-discharge were 94%, 87%, and 83%.
- Genetic syndromes were a significant mortality risk factor; observed-to-expected interstage mortality was 0.57 (P=.04).
Conclusions:
- Small-volume centers can achieve survival rates similar to large-volume centers for Norwood procedures.
- Specific institutional factors, achievable with resource allocation, may explain these outcomes.
- Findings challenge the traditional volume-outcome correlation for Norwood procedures.
