Abstract 9473: Patient, Operative, and Center Factors Impacting Post-operative Outcomes in Patients Undergoing the Fontan Operation: Analysis of a National Clinical Database
Background: Contemporary data regarding factors impacting outcome following the Fontan operation are limited. We evaluated patient, operative, and center factors associated with post-operative outcomes using a large multi-institutional clinical registry.
Methods: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation from 2000–2009 were included. Demographics, diagnoses, pre-operative factors, operative data, and center annual Fontan volume were collected. Outcomes evaluated included in-hospital mortality, Fontan failure (combined in-hospital mortality and Fontan takedown or revision), and post-operative length of stay (LOS). Multivariable analysis, utilizing hierarchical logistic and linear regression with hospital specific intercepts to account for within center clustering, was performed to evaluate the independent association of patient, operative, and center factors with outcome.
Results: A total of 2747 patients from 68 centers were included: 61% male, median age 3.0y [interquartile range (IQR) 2.3–3.6], 45% right dominant lesions (vs. 38% left dominant, 17% undifferentiated). An extracardiac (vs. lateral tunnel) Fontan was performed in 63%, and 62% overall were fenestrated. Overall, unadjusted mortality was 1.6%, Fontan failure 2.7%, and median LOS 9d (IQR 7–14). Factors significantly associated with post-operative outcomes in multivariable analysis are displayed in the table.
Conclusions: These data suggest patient weight, diagnosis, and other pre-operative factors, along with type of Fontan operation performed, and center volume are important factors impacting outcome following the Fontan operation in this contemporary cohort. Further understanding of the influence and interaction of patient factors and type of Fontan operation performed may lead to strategies to improve outcomes.
- © 2010 by American Heart Association, Inc.