Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA.
Quality Management, Medical University of South Carolina, Charleston, SC, USA.
Cardiol Young. 2022 Nov;32(11):1794-1800. doi: 10.1017/S1047951121004996. Epub 2021 Dec 28.
Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres.
The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation.
Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0-20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8-2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0-4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2-2.2; p < 0.01). Centre average surgical volume was not a significant risk factor.
Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.
关于危重新生儿先天性心脏病（CHD）术前死亡率的数据很少，这将有助于患者护理和家庭咨询。本研究的目的是利用多中心行政数据集报告美国各中心危重新生儿 CHD 患者术前院内死亡率的发生率，并确定其危险因素。
利用小儿健康信息系统数据库搜索出生≤30 天、2009 年 1 月 1 日至 2018 年 6 月 30 日、ICD-9/10 编码为大动脉转位、共同动脉干、主动脉弓中断或左心发育不良综合征的新生儿。术前院内死亡率定义为在没有心脏手术或介入导管术的 ICD 编码的情况下，患者在出院前死亡。
总体术前死亡率至少为 5.4%（690/12739），不同诊断（d-TGA 2.9%、TA 8.3%、IAA 5.5%和 HLHS 7.3%）和中心（0-20.5%）之间存在差异。多变量分析显示，与术前死亡率相关的危险因素包括早产（<37 周）（OR 2.3，95%CI：1.8-2.9；p<0.01）、低出生体重（<2.5kg）（OR 3.8，95%CI：3.0-4.7；p<0.01）和遗传异常（OR 1.6，95%CI：1.2-2.2；p<0.01）。中心平均手术量不是一个显著的危险因素。
大约每 20 名危重新生儿 CHD 患者中就有 1 名发生术前院内死亡，且死亡率在不同诊断和中心之间存在差异。更好地了解导致这种差异的因素（例如患者因素、术前护理模式、手术时机）可能有助于确定患者护理改进的机会，并为与家属的沟通提供信息。
