1. Gregory Sturz1, Howard Gutgesell2, Mark Conaway3 and Peter Dean2
Influence of Comorbid Conditions on Surgical Outcomes for Congenital Heart Disease
Gregory Sturz1, Howard Gutgesell2, Mark Conaway3 and Peter Dean2
1Dept. Of Pediatrics, 2Division of Pediatric Cardiology, 3Dept. Public Health Sciences, University of Virginia, Charlottesville, VA 22908
Background
The incidence of congenital heart disease (CHD) is less that 1% live births. Of children with CHD, between 25-30% will have some form of extra-cardiac anomaly or genetic syndrome (De Decker 2011). These comorbid conditions often complicate the care of patients with CHD.
It is not known how comorbid conditions influence the outcomes for patients undergoing an operation for CHD.
Hypothesis: The presence of pre-surgical comorbidities will surgical outcomes for patients under the age of 18 undergoing congenital heart surgery.
Results
Plot of estimate and 95% CI for estimated charges. Those with the comorbitity relative to those without the comorbidity. N
Mean (SD)
Median (Q1-Q3)
Min-Max
Age (month)
15453
25.2 (43.5)
6.0 (1-31)
0 – 215
Length of Stay (Days)
19.1 (30.0)
9.0 (5-20)
0-374
Estimated Charges ($, thousands)
15452
301.4 (513.9)
138.3 ( )
ICU LOS
15358
12.5 (24.7)
5.0 (2-12)
0-353 A. B.
Comorbidities N %
Down Syndrome
909
5.9%
DiGeorge Syndrome
473
3.1%
Other Congenital Syndromes (i.e. Edward, Patau, William’s, Other)
339
2.2%
All Genetic Malformations
1711
11.1%
GI Malformations
323
2.1%
Renal Abnormalities
329
CNS Malformations
231
1.5%
Prematurity or low birth weight
409
2.6%
Infant of diabetic mother 57
0.4%
Methods
We queried the University HealthSystem Consortium (UHC) database for patients less than 18 years old who underwent an operation for CHD between 2006 and 2012
UHC is a cooperative of 117 not-for-profit academic medical centers who share data for performance improvement. They maintain the CDB/RM, a database containing patient encounter information on demographics, diagnoses, procedures and other aspects of patient encounters.
We prospectively picked comorbid conditions that are often encountered in the treatment of children with congenital heart disease.
Comorbid conditions and Risk Adjustment in Congenital Heart Disease (RACHS-1) classifications were determined by International Classification of Diseases, Ninth Revision and Current Procedural Terminology (CPT) codes.
Regression analysis was used to test the effect of comorbid conditions on hospital mortality, length of hospital stay and estimated charges. We controlled for RACHS-1 classification, age at admission and hospital volume. A p-value of ≤ 0.5 was considered significant.
Plot of estimate and 95% CI for mortality. Those with the comorbitity relative to those without the comorbidity.
Plot of estimate and 95% CI for LOS. Those with the comorbitity relative to those without the comorbidity.
Conclusions
This is the first comprehensive investigation of frequently encountered comorbidities on surgical outcomes for congenital heart surgery. CNS malformations, DiGeorge Syndrome and prematurity were associated with increased mortality, LOS and estimated cost. GI malformations, renal abnormalities and genetic syndromes were associated with an increased LOS and cost without an increase in mortality. Down Syndrome was associated with a decrease in LOS and estimated charges without an associated decreased in hospital mortality.
There are no conflicts of interests to be disclosed by any of the authors
Questions: