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Neonatal Tetralogy of Fallot Complete Repair Is Associated with Increased Mortality and Morbidity

Friday, October 19, 2012: 4:00 PM
Room 275-277 (Morial Convention Center)
Matthew B. Steiner, M.D., Parthak Prodhan, M.D., Jeffrey Gossett, M.S., Xinyu Tang, PhD and Sadia Malik, M.D., Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR

Neonatal Tetralogy of Fallot Complete Repair is Associated with Increased Mortality and Morbidity

Purpose:  Controversy and cross-center variability exists with regards to timing of complete repair for non-ductal dependent tetralogy of Fallot (TOF) patients. We hypothesized that earlier repair of infants in the neonatal period is associated with increased mortality and morbidity.

Methods: This retrospective study involved querying the Pediatric Health Information System (PHIS), a multicenter database of pediatric hospitalizations from 43 children’s hospitals in the United States, for total surgical repair (ICD-9 procedure code 35.81) of tetralogy of Fallot (ICD-9 diagnostic code 745.2) from 2003 to 2011 in patients between the ages of 1 day to <19 years of age. Patients with pulmonary valve atresia (ICD-9 diagnostic code 745.1) and patients with TOF who received prostaglandin during the admission were excluded from the analysis. Patient demographic data and data relating to post-operative outcomes were abstracted from the database. Age at time of surgery and its association with immediate in-hospital outcomes was analyzed by univariate statistics and proportional hazard model for competing risk using Stata Version 11. A p value of < 0.05 was considered to be statistically significant.

<![if !vml]><![endif]>Results:

We identified 5629 patients who met our inclusion criteria of which 6.7% (n=378) were <30 days of age (Group A), 29.0% (n=1631) were 31 to 120 days of age (Group B), and 64.3% (n=3620) were > 120 days of age (Group C). In-hospital mortality was significantly higher in Group A (7%) vs. Group B (1%) and Group C (1%); p <0.001. ICU length of stay (LOS) was significantly higher in Group A (median 10 days, inter quartile range [IQR] 6-18 days) compared to Group B (median 5 days, IQR 3-8 days) and Group C (median 4 days, IQR 2-6 days). Similarly, total hospital LOS was significantly higher in Group A (median 19 days, IQR 13–34 days) compared to Group B (median 8 days, IQR 6-15 days) and Group C (median 7 days, IQR 5–11 days). Group A compared to Group B and Group C patients were more like to require extracorporeal membrane oxygenation support (4% vs. 2% vs. 1%; p value <0.001) and gastrostomy tube insertion (7% vs. 3% vs. 1%; p value <0.001). Significant institutional variability was noted for timing of TOF complete repair (p value < 0.001).

Conclusion: Neonatal complete TOF repair is associated with increased mortality and morbidity (ICU LOS, total hospital LOS, an increased need for ECMO and gastrostomy tube placement).