Skip to main content
Erschienen in: Pediatric Cardiology 1/2020

22.11.2019 | Original Article

Trends in Infant Mortality After TAPVR Repair over 18 Years in Texas and Impact of Hospital Surgical Volume

verfasst von: Subhrajit Lahiri, Yunfei Wang, Christopher A. Caldarone, Shaine A. Morris

Erschienen in: Pediatric Cardiology | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

For some congenital heart lesions, higher institutional surgical volume has been associated with better survival than in lower volume centers. The relationship between institutional surgical volume and mortality in infants after total anomalous pulmonary vein return (TAPVR) repair has not been well explored. The Texas Inpatient Public Use Data File was queried for hospitalizations including TAPVR repair in infants between January 1, 1999 and December 31, 2016. We first evaluated the change in mortality over the study period. We then evaluated associations between institutional TAPVR surgical volume and mortality using univariable analysis and multivariable analysis accounting for center effects. For secondary analyses, we evaluated the association between volume and mortality among non-mutually exclusive TAPVR subsets, including isolated TAPVR, TAPVR with other congenital heart disease (CHD), TAPVR with heterotaxy, and TAPVR with single ventricle anatomy. Of 971 surgical hospitalizations that met inclusion criteria, 62% were male. Mortality after TAPVR repair decreased over the study period from 15.1% (1999–2004) to 7.6% (2012–2016) with an odds ratio per increasing year of 0.96 (95% CI 0.92–0.99, p = 0.030). By univariable analysis, earlier era, preterm birth, lower institutional surgical volume, heterotaxy, and additional CHD were associated with increased mortality. Institutional surgical volume remained significant in multivariate analysis with an odds ratio per increase in surgical volume of every 10 patients of 0.93 (95% CI 0.90–0.96, p < 0.001). When examining by subgroup, isolated TAPVR had the lowest mortality (n = 606, mortality = 6%), compared to TAPVR with other CHD (n = 359, mortality = 20%), TAPVR with heterotaxy (n = 135, mortality = 21%), and TAPVR with single ventricle (n = 128, mortality = 23%). In all groups except those with single ventricle, higher surgical volume was associated with lower mortality in multivariate analyses (isolated TAPVR p = 0.001, TAPVR with other CHD p = 0.009, TAPVR with heterotaxy p < 0.001, TAPVR with single ventricle p = 0.161). This is the first study to demonstrate an association between institutional surgical volume and mortality after TAPVR repair. Higher volume centers are associated with lower hospital mortality after TAPVR repair, including TAPVR with other CHD.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI (1995) In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323–330PubMed Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI (1995) In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323–330PubMed
4.
Zurück zum Zitat Mai CT, Kucik JE, Isenburg J, Feldkamp ML, Marengo LK, Bugenske EM et al (2013) Selected birth defects data from population‐based birth defects surveillance programs in the United States, 2006 to 2010: featuring trisomy conditions. 97:709–725. https://doi.org/10.1002/bdra.23198 CrossRef Mai CT, Kucik JE, Isenburg J, Feldkamp ML, Marengo LK, Bugenske EM et al (2013) Selected birth defects data from population‐based birth defects surveillance programs in the United States, 2006 to 2010: featuring trisomy conditions. 97:709–725. https://​doi.​org/​10.​1002/​bdra.​23198 CrossRef
Metadaten
Titel
Trends in Infant Mortality After TAPVR Repair over 18 Years in Texas and Impact of Hospital Surgical Volume
verfasst von
Subhrajit Lahiri
Yunfei Wang
Christopher A. Caldarone
Shaine A. Morris
Publikationsdatum
22.11.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 1/2020
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02224-x

Weitere Artikel der Ausgabe 1/2020

Pediatric Cardiology 1/2020 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.