Abstract 2001: Outcome of Tetralogy of Fallot in the United States: The Influence of Neonatal vs. Non-Neonatal Repair
Introduction: Controversy exists regarding the optimal timing of repair for tetralogy of Fallot (TOF). Little data exist outside of single center studies as to the morbidity, mortality, and cost associated with neonatal (≤30 days-old) vs. non-neonatal repair.
Hypothesis: We tested the hypothesis that neonatal repair of TOF would be associated with higher morbidity, mortality, and hospital charges.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids’ Inpatient Database, a nationwide database of pediatric hospital discharges that is weighted to provide national estimates, was performed to determine the morbidity, mortality, and hospital charges for complete repair of TOF in 2006. All analyses were performed on weighted values.
Results: 1,929 patients (95% CI 1,522 to 2,318) underwent TOF repair with age at operation data in 1,479 (95% CI 1,135 to 1,823). Only 73 (4.9%) (95% CI 3.2% to 7.6%) underwent neonatal repair. Neonatal repair was associated with higher hospital mortality (14.3%, 95% CI 6.9% to 27.2%) compared to non-neonatal repair (1.4%, 95% CI 0.7% to 2.5%) [odds ratio (OR) 11.8, 95% CI 4.2 to 32.3]. The mortality of patients with unknown age at operation was 3.9% (95% CI 1.7% to 3.5%). Neonatal repair was associated with longer postoperative length of stay (LOS) (mean 22 days, 95%CI 17 to 28 days) and greater hospital charges (mean $346,573, 95% CI $234,720 to $458,428) compared to non-neonatal repair (mean postoperative LOS 10 days, 95% CI 8 to 11 days and mean charges $141,952, 95% CI $114,032 to $169,872) (p<0.001 for both). The incidence of arrhythmias, renal failure, pneumonia, and strokes was similar among patients with neonatal vs non-neonatal repair; however, neonatal repair patients were at greater risk for seizures (OR 3.5, 95% CI 1.3 to 8.0) and sepsis (OR 5.6, 95% CI 2.3 to 13.3). On multivariable analysis, controlling for gender, ethnicity, hospital characteristics, and geographic region, neonatal repair was independently associated with mortality (OR 9.7, 95% CI 2.4 to 38.5).
Conclusions: In this largest study of TOF repair in the current era, neonatal complete repair of TOF represented < 5% of patients and was associated with an increased postoperative LOS, greater hospital charges, and increased mortality.