Transposition of the Great Arteries—Outcomes and Time Interval of Early Neonatal Repair. (April 2014)

• Record Type: Journal Article
• Authors: Cain, Michael T.; Cao, Yumei; Ghanayem, Nancy S.; Simpson, Pippa M.; Trapp, Katie; Mitchell, Michael E.; Tweddell, James S.; Woods, Ronald K.
• Is Part Of: World journal for pediatric & congenital heart surgery. Volume 5:Number 2(2014:Apr.)
• Page Start: 241
• Page End: 247
• Publication Date: 2014-04
• Subjects: congenital heart disease -- neonate -- outcomes -- great vessel anomaly; Pediatric cardiology -- Periodicals; Congenital heart disease in children -- Periodicals; Heart -- Abnormalities -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; Heart Defects, Congenital -- surgery -- Periodicals; Cardiac Surgical Procedures -- Periodicals; Child -- Periodicals; Adult -- Periodicals; 618.9212
• DOI: 10.1177/2150135113520559
• Languages: English
• ISSNs: 2150-1351

Abstract

Background: This study evaluates the relationship of morbidity and resource utilization with the timing of early neonatal repair of transposition of the great arteries and intact ventricular septum (d-TGA/IVS). Methods: All patients with d-TGA/IVS who underwent arterial switch in the first 14 days of life, between January 2000 and May 2011, were reviewed. Patients undergoing repair at ≤4 days of age were categorized as group I, 5 to 7 days as group II, and 8 to 14 days as group III. Outcomes included mortality, morbidity, and resource utilization. Results: Hospital survival was 69 (98.6%) of 70. The length of stay (LOS) and total charges were lowest in group I—15.5 days compared to group II—18.0 days and group III—23.5 days ( P = .005); group I—US$128, 219 compared to group II—US$141, 729 and group III—US$217, 427 ( P = .0006). Using regression analysis to account for potentially confounding effects of multiple variables and treating time as a continuous variable demonstrated that age at surgery was significantly associated with total LOS ( P = .029), hospital charges ( P = .029) and intensive care unit charges ( P = .002). Younger age at repair was not associated with worse outcomes for any measure of morbidity. Conclusions: Earlier repair of d-TGA/IVS was associated with decreased resource utilization and no detriment to clinical outcomes. Further analysis based on a larger cohort of patients is needed to verify these results that have important implications for improving the value of care.