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

Zeitschrift:: Pediatric Cardiology > Ausgabe 1/2020

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

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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.

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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 95:323–330 PubMed

Karamlou T, Diggs BS, Ungerleider RM, Welke KF (2009) Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards. 87:216–223. https://doi.org/10.1016/j.athoracsur.2008.10.032 CrossRef

Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B (2005) The effect of surgical case volume on outcome after the Norwood procedure. 129:754–759. https://doi.org/10.1016/j.jtcvs.2004.07.056 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

Karamlou T, Diggs BS, Ungerleider RM, Welke KF (2008) The relationship between hospital surgical case volumes and mortality rates in pediatric cardiac surgery: a national sample, 1988–2005. 86:889–896. https://doi.org/10.1016/j.athoracsur.2008.04.077 CrossRef

Khan MS, Bryant R III, Kim SH, Hill KD, Jacobs JP, Jacobs ML, Pasquali SK, Morales DL (2015) Contemporary outcomes of surgical repair of total anomalous pulmonary venous connection in patients with heterotaxy syndrome. 99:2134–2140. https://doi.org/10.1016/j.athoracsur.2015.02.035 CrossRef

Pasquali SK, |Jacobs JP, He X, Hornik CP, Jaquiss RD, Jacobs ML, O’Brien SM, Peterson ED, Li JS (2012) The complex relationship between center volume and outcome in patients undergoing the Norwood operation. 93:1556–1562. https://doi.org/10.1016/j.athoracsur.2011.07.081 CrossRef

Luft H, Bunker JP, Enthoven AC (1979) Should surgeries be regionalized? 301:1364–1369. https://doi.org/10.1056/NEJM198603273141302 CrossRef

Lara DA, Fixler DE, Ethen MK, Canfield MA, Nembhard WN, Morris SA (2016) Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries. 106:739–748. https://doi.org/10.1002/bdra.23525 CrossRef

10.

Morris SA, Ethen MK, Penny DJ, Canfield MA, Minard CG, Fixler DE et al (2014) Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. 129:285–292. https://doi.org/10.1161/CIRCULATIONAHA.113.003711 CrossRef

11.

Kelle AM, Backer CL, Gossett JG, Kaushal S, Mavroudis C (2010) Total anomalous pulmonary venous connection: results of surgical repair of 100 patients at a single institution. 139:1387–1394.e3. https://doi.org/10.1016/j.jtcvs.2010.02.024 CrossRef

Titel: Trends in Infant Mortality After TAPVR Repair over 18 Years in Texas and Impact of Hospital Surgical Volume
Autoren:: Subhrajit Lahiri
Yunfei Wang
Christopher A. Caldarone
Shaine A. Morris
Publikationsdatum: 22.11.2019
DOI: https://doi.org/10.1007/s00246-019-02224-x
Verlag: Springer US
Zeitschrift: Pediatric Cardiology
Ausgabe 1/2020
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971

Sie können e.Med Pädiatrie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.