Abstract 17921: Complications During Adult Congenital Heart Surgery Admissions: Frequency and Impact on Patient Outcomes
Objective: Adults with congenital heart disease are a complex patient population and are frequently admitted for congenital heart surgery. The frequency of complications during these admissions and their association to patient outcome is not well known. Our objectives are to 1) define the frequency of complications during Adult Congenital Heart (ACH) surgery admissions, 2) determine the association of complications with death and resource use, and 3) identify risk factors for complications.
Methods: We identified ACH surgery admissions ages 18 to 49 during the years 2005 - 2009 from the Nationwide Inpatient Sample database. Complications were defined according to the Society of Thoracic Surgeons Short List of Complications for congenital heart surgery. We examined the relationship of complications to admission demographic and clinical data, length of stay, hospital charges, and death. We identified risk factors for complications using a generalized estimating equations model.
Results: We identified 16,841 ACH surgery admissions, of which 42.8% had at least one complication. Respiratory (18.2%) and cardiac (18.3%) complications were the most common, followed by acute kidney injury (6.8%), and infection (6.7%). Admissions with any complication had a longer length of stay (10 days vs. 6 days; p < 0.001), increased charges ($138,989 vs. $87,471; p < 0.001), and higher mortality (4.6% vs. 1.4%; p < 0.001) compared to admissions without a complication. Adjusted risk factors for complications included older age (46-49 years OR 1.2; 95% CI 1.0,1.3; p = 0.019), non-White race (OR 1.2; 95% CI 1.1,1.4; p < 0.001), government insurance (OR 1.6; 95% CI 1.4,1.7; p < 0.001), alcohol abuse (OR 1.2; 95% CI 1.0,1.5; p = 0.049), high surgical complexity (category 3+; OR 1.6; 95% CI 1.3,2.0; p < 0.001), and emergent admission (OR 1.7; 95% CI 1.5,2.0; p < 0.001). In multivariate analysis, complications were independently associated with death (OR 1.9; 95% CI 1.5, 2.5; p < 0.001).
Conclusions: Complications occur frequently during ACH surgery admissions and are associated with increased resource use and are a risk factor for death. Knowledge of risk factors and future study to identify potential preventability of complications may improve the outcomes of these complex patients.
- © 2013 by American Heart Association, Inc.