Williamson Catherine G, Ebrahimian Shayan, Kim Shineui, Vadlakonda Amulya, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles California.
Ann Thorac Surg Short Rep. 2023 Apr 5;1(3):431-435. doi: 10.1016/j.atssr.2023.03.018. eCollection 2023 Sep.
As patients with congenital heart disease are increasingly surviving well into adulthood, the morbidity, mortality, and resource utilization of adult congenital cardiac operations are of increasing interest. Therefore, we evaluated factors associated with perioperative morbidity and outcomes in adults undergoing congenital operations.
The Nationwide Readmissions Database was tabulated for all adults (≥18 years old) with congenital heart disease between 2010 and 2017. Congenital operations were identified by previously published and codes. Complications were selected on the basis of The Society of Thoracic Surgeons short list of complications. Multivariable regression models were used to assess adjusted odds ratios (AORs) and β coefficients for select clinical outcomes.
Of 52,360 adults identified who underwent congenital cardiac operations, 14,123 (27%) suffered a complication. The presence of a complication increased the odds of index death (AOR, 11.46; 95% CI, 8.58-15.31), nonhome discharge (AOR, 2.09; 95% CI, 1.91-2.29), 30-day readmission (AOR, 2.12; 95% CI, 1.88-2.39), 90-day readmission (AOR, 2.17; 95% CI, 1.94-2.43), costs (β, +$37,000; 95% CI, $34,000-$40,000), and hospital duration (β, +7.86 days; 95% CI, 7.3-8.4).
Perioperative complications portend in-hospital death, resource use, and readmissions in adults undergoing congenital heart operations. As complications are present in 27% of this population, identification of risk stratification and complication-reducing strategies may improve patient morbidity, mortality, and resource utilization.
随着先天性心脏病患者越来越多地顺利活到成年，成人先天性心脏手术的发病率、死亡率和资源利用情况越来越受到关注。因此，我们评估了接受先天性手术的成人围手术期发病率及预后的相关因素。
整理2010年至2017年间全国再入院数据库中所有患有先天性心脏病的成人（≥18岁）的数据。先天性手术通过先前公布的代码识别。并发症根据胸外科医师协会的并发症简短清单进行选择。多变量回归模型用于评估选定临床结局的调整优势比（AOR）和β系数。
在52360名接受先天性心脏手术的成人中，14123人（27%）出现了并发症。出现并发症会增加指数死亡的几率（AOR，11.46；95%CI，8.58 - 15.31）、非家庭出院的几率（AOR，2.09；95%CI，1.91 - 2.29）、30天再入院的几率（AOR，2.12；95%CI，1.88 - 2.39）、90天再入院的几率（AOR，2.17；95%CI，1.94 - 2.43）、费用（β，+$37000；95%CI，$34000 - $40000）以及住院时间（β，+7.86天；95%CI，7.3 - 8.4）。
围手术期并发症预示着接受先天性心脏手术的成人会出现院内死亡、资源利用和再入院情况。由于该人群中有27%出现并发症，识别风险分层和降低并发症的策略可能会改善患者的发病率、死亡率和资源利用情况。
