Five-year Analysis of Operative Mortality and Neonatal Outcomes in Congenital Heart Disease

详细信息    查看全文

• 作者：James R. Padley PhD<sup>asup><sup> ; sup><sup>esup> ; Andrew D. Cole B App Sci (Hons)<sup>asup> ; Victoria E. Pye B Med Sci<sup>asup> ; Richard B. Chard FRACS<sup>asup><sup> ; sup><sup>esup> ; Ian A. Nicholson FRACS<sup>asup><sup> ; sup><sup>esup> ; Stephen Jacobe FCICM<sup>csup><sup> ; sup><sup>esup> ; David Baines FANZCA<sup>dsup><sup> ; sup><sup>esup> ; Nadia Badawi PhD<sup>bsup><sup> ; sup><sup>esup> ; Karen Walker MN<sup>bsup><sup> ; sup><sup>esup> ; Gabbie Scarfe MN<sup>asup> ; Karen Leclair MN<sup>asup> ; Gary F. Sholler FRACP<sup>asup><sup> ; sup><sup>esup> ; David S. Winlaw FRACS<sup>asup><sup> ; sup><sup>esup><sup> ; sup><sup>davidw@chw.edu.au"" rel=""nofollowsup>
• 关键词：Congenital heart disease ; Outcomes ; Neonate
• 刊名：Heart, Lung and Circulation
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：20
• 期：7
• 页码：460-467
• 全文大小：154 K

文摘

ss=""h4"">Background

We sought to compare overall mortality with neonatal outcomes over a five year period to define risk factors for mortality and service development priorities.

ss=""h4"">Methods

A retrospective cohort study of surgical outcomes following repair or palliation of structural congenital heart defects January 2005–2010. We defined mortality according to contemporary international guidelines and classified surgical procedures using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The effect of age and weight at operation on mortality and annual variation in case-complexity and surgeon case-mix were assessed. Subgroup analysis was performed in patients who were ≤30 days at operation (neonates).

ss=""h4"">Results

Overall mortality within 30 days of operation or prior to hospital discharge was 1.3 and 1.9 % , respectively. Mortality was higher in neonates (6.8 % ) and low birth weight infants (≤2.5 kg) (12.1 % ). Mortality was similar in bypass versus non-bypass procedures (odds ratio 0.74, p = 0.425). Annual mortality rates were consistent despite a marked increase in case-complexity. Neonates overall required longer periods of intensive care support and were more likely to suffer serious complications compared to older children. Age, weight and RACHS-1 score were independent risk factors for mortality on multivariate analysis. In neonates undergoing bypass procedures, only RACHS-1 score was a significant risk factor.

ss=""h4"">Conclusions

This study provides an accurate and contemporary audit of mortality risk associated with congenital heart surgery. Outcomes compare favourably to international benchmarks but highlight the risks of morbidity and mortality associated with neonatal cardiac surgery.