Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Biostatistics, Harvard School of Public Health, Boston, Mass.
J Thorac Cardiovasc Surg. 2023 Feb;165(2):436-446. doi: 10.1016/j.jtcvs.2022.04.033. Epub 2022 May 15.
Outcomes after first-stage palliation of single-ventricle heart disease are influenced by many factors, including the presence of residual lesions requiring reintervention. However, there is a dearth of information regarding the optimal timing of reintervention. We assessed if earlier reintervention would be favorably associated with in-hospital outcomes among patients requiring unplanned reinterventions after the Norwood operation.
This was a single-center, retrospective review of all patients who underwent the Norwood procedure from January 1997 to November 2017 and required a predischarge unplanned surgical or transcatheter reintervention on 1 or more subcomponent areas repaired at the index operation. Outcomes of interest included in-hospital mortality or transplant, postoperative hospital length of stay, and inpatient cost. Associations between timing of reintervention and outcomes were assessed using logistic regression (mortality or transplant) or generalized linear models (postoperative hospital length of stay and cost), adjusting for baseline patient-related and procedural factors.
Of 500 patients who underwent the Norwood operation, 92 (18.4%) required an unplanned reintervention. Median time to reintervention was 12 days (interquartile range, 5-35 days). There were 31 (33.7%) deaths or transplants, median postoperative hospital length of stay was 49 days (interquartile range, 32-87 days), and median cost was $328,000 (interquartile range, $204,000-$464,000). On multivariable analysis, each 5-day increase in time to reintervention increased the odds of mortality or transplant by 20% (odds ratio, 1.2; 95% confidence interval, 1.1-1.3; P = .004). Longer time to reintervention was also significantly associated with greater postoperative hospital length of stay (P < .001) and higher cost (P < .001).
For patients requiring predischarge unplanned reinterventions after the Norwood operation, earlier reintervention is associated with improved in-hospital transplant-free survival and resource use.
单心室心脏病一期姑息治疗的结果受多种因素影响，包括需要再次介入治疗的残余病变。然而，关于再次介入治疗的最佳时机的信息却很少。我们评估了在接受 Norwood 手术后需要计划外再次手术或经导管介入治疗的患者中，早期再次介入治疗是否与住院期间的结果有利相关。
这是一项单中心、回顾性研究，纳入了 1997 年 1 月至 2017 年 11 月期间接受 Norwood 手术且在索引手术中修复的一个或多个亚组分区域需要在出院前进行计划外手术或经导管再次介入治疗的所有患者。研究结果包括住院期间的死亡率或移植、术后住院时间和住院费用。使用逻辑回归（死亡率或移植）或广义线性模型（术后住院时间和费用）评估再次介入治疗时机与结果之间的关系，同时调整了基线患者相关和程序因素。
在 500 例接受 Norwood 手术的患者中，有 92 例（18.4%）需要进行计划外再次介入治疗。再次介入治疗的中位时间为 12 天（四分位间距，5-35 天）。有 31 例（33.7%）死亡或移植，术后住院时间的中位数为 49 天（四分位间距，32-87 天），中位费用为 32.8 万美元（四分位间距，20.4 万美元-46.4 万美元）。多变量分析显示，再次介入治疗时间每增加 5 天，死亡率或移植的风险增加 20%（比值比，1.2；95%置信区间，1.1-1.3；P=0.004）。再次介入治疗时间延长与术后住院时间延长（P<0.001）和费用增加（P<0.001）显著相关。
对于接受 Norwood 手术后需要计划外再次介入治疗的患者，早期再次介入治疗与改善住院期间无移植存活率和资源利用相关。
