Association of Surgical Complications With Resource Utilization in Adult Congenital Cardiac Surgery

As patients with congenital heart disease are increasingly surviving well into adulthood, the morbidity, mortality, and resource utilization of adult congenital cardiac operations are of increasing interest. Therefore, we evaluated factors associated with perioperative morbidity and outcomes in adults undergoing congenital operations.

The Nationwide Readmissions Database was tabulated for all adults (≥18 years old) with congenital heart disease between 2010 and 2017. Congenital operations were identified by previously published International Classification of Diseases, Ninth Revision and Tenth Revision codes. Complications were selected on the basis of The Society of Thoracic Surgeons short list of complications. Multivariable regression models were used to assess adjusted odds ratios (AORs) and β coefficients for select clinical outcomes.

Of 52,360 adults identified who underwent congenital cardiac operations, 14,123 (27%) suffered a complication. The presence of a complication increased the odds of index death (AOR, 11.46; 95% CI, 8.58-15.31), nonhome discharge (AOR, 2.09; 95% CI, 1.91-2.29), 30-day readmission (AOR, 2.12; 95% CI, 1.88-2.39), 90-day readmission (AOR, 2.17; 95% CI, 1.94-2.43), costs (β, +$37,000; 95% CI, $34,000-$40,000), and hospital duration (β, +7.86 days; 95% CI, 7.3-8.4).

Perioperative complications portend in-hospital death, resource use, and readmissions in adults undergoing congenital heart operations. As complications are present in 27% of this population, identification of risk stratification and complication-reducing strategies may improve patient morbidity, mortality, and resource utilization.