Early Reoperations in a 5-Year National Cohort of Pediatric Patients With Congenital Heart Disease

BACKGROUND: The exact types, frequency, and consequences of early congenital cardiac reoperations are not well known. We aim to describe them and evaluate the potential of early reoperations as a metric for quality of care.

METHODS: A retrospective analysis of the 2005 through 2010 National Congenital Heart Disease Audit database was performed. An early cardiac reoperation sequence was defined as one taking place within a 30-day episode.

RESULTS: A total of 18,489 cardiac surgical procedures were analyzed, 652 (3.5%) being early cardiac reoperations, part of 588 sequences. The most common index procedures were arterial shunt, coarctation or hypoplasia of the aorta repair, and pulmonary artery banding. The most common reoperations were arterial shunt, pulmonary artery band, and ventricular septal defect procedures. The 60-day mortality was significantly higher in patients having an early reoperation, with 93 early deaths, compared with those who did not (15.8% versus 3%; p < 0.001). From these 93 early deaths, 42 (45%) followed a Norwood, arterial shunt, or pulmonary artery band performed as an index or reoperation. Reoperations were classified as related and unrelated to the index procedure. A related-to-unrelated reoperation ratio was calculated, ranging from 0.2 for coarctation or hypoplasia to 9.0 for atrioventricular septal defect repair.

CONCLUSIONS: Early reoperations can be variably related to the index procedure, ranging from repeat of index to repair of associated defects and staged procedures, resulting in different patterns of reoperation types by relationship to the index. Cardiac reoperations within 30 days are associated with increased mortality, which is clustered around a small number of procedures.