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Contemporary Real-world Outcomes of Stage 1 Palliation for Single-ventricle Patients: A Kids' Inpatient Database
Dhaval Chauhan1, J Hunter Mehaffey1, J W Awori Hayanga1
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, 26506, United States.
Objectives:
Patients with a single ventricle and systemic outflow obstruction undergo 1 of 3 stage 1 palliative operations: Norwood-Sano, Norwood-Modified Blalock-Taussig-Thomas shunt (mBTTs), or stage 1 hybrid palliation. We evaluated real-world outcomes for patients undergoing stage 1 palliation strategies in a national dataset.
Methods:
The Kids' Inpatient Database (KID) was queried for patients undergoing Norwood and hybrid procedures for the years 2016, 2019, and 2019. Data were extracted using International Classification of Diseases (ICD-10) codes. Using survey weights, an estimated national cohort was derived. Multilevel, multivariable logistic regression models evaluated risk-adjusted mortality and post-operative extracorporeal membrane oxygenation (ECMO). Operations were plotted by hospital mortality for the entire sample.
Results:
A total of 1918 patients underwent stage 1 palliation with Norwood-Sano (1046, 54.5%), Norwood-mBTT shunt (770, 40.1%), or hybrid procedure (102, 5.3%). Unadjusted inpatient mortality was 9.0% for Norwood-Sano, 11.5% for Norwood-mBTT shunt, and 18.7% for the hybrid procedure. After risk adjustment, there was no significant difference in risk-adjusted inpatient mortality for Norwood-mBTTs (OR 1.25, P = .248) or hybrid procedures (OR 2.01, P = .057) compared to Norwood-Sano. There was no difference in need for ECMO for Norwood-mBTT shunt (OR 0.90, P = .78), or hybrid procedure (OR 0.50, P = .37). Finally, compared to Norwood-Sano, the use of mBTTs or hybrid procedures was higher in high-mortality hospitals.
Conclusions:
Compared to historical data, outcomes for stage 1 palliative procedures are improving over historical norms. There was no difference in risk-adjusted inpatient mortality or ECMO comparing Norwood-Sano to Norwood-mBTTs. These data may aid the evolution of operative strategies.
