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Arterial switch operation (ASO) is now the standard of care for neonates with dextrotransposition of the great arteries (TGA). With widespread availability of prostaglandins and balloon septostomy, timing of surgery has become largely discretionary. Little is known about the effects of age at operation on either clinical outcomes or costs of management. Our aim was to examine the impact of timing of surgery during the first month of life on major morbidity or mortality and on hospital reimbursement for term infants with uncomplicated TGA.
We conducted a retrospective cohort study of term infants with simple TGA, with or without ventricular septal defect (VSD), admitted to our institution at < 5 days of age, from Jan 1, 2003 to July 1, 2012. Children with major co-morbid conditions were excluded. Clinical and financial records were obtained, and univariable and multivariable analyses performed to determine the effects of age at operation on major morbidity (arrest, ECMO, delayed sternal closure, systemic infection, necrotizing enterocolitis, seizure, stroke, reoperation and readmission) or mortality and on hospital reimbursement.
141 children met inclusion criteria. One child died preoperatively on day of life zero, while awaiting balloon septostomy. 140 children underwent ASO. Reimbursement data was available for children through Jan 1, 2012 (n = 131). Mortality was 1.4% (n = 2). An additional 24% (n = 33) experienced a major morbidity. Median hospital costs were $61,000 in 2012 dollars ($25,000 – $549,000), with a median length of stay of 13 days (5-122). Median age at operation was 5 days (1-18; 98% at < 12). For every day later that surgery was performed, the odds of major morbidity or mortality increased by 21% (3-43%; P = 0.020) and costs increased by 7% (4-9%; P < 0.001), after considering the effects of inflation, sex, birth weight, date, transfer, weekend admission, insurance, surgeon, balloon septostomy, bypass and cross-clamp times, and the presence of VSD, left ventricular outflow tract or arch obstruction, or abnormal coronary anatomy.
Delay in surgical correction of TGA, with or without VSD, significantly increases morbidity and healthcare costs.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Congenital Heart Surgery
Abstract Category: 14. Congenital Cardiology Solutions: Therapy
Presentation Number: 1205M-140
- 2013 American College of Cardiology Foundation