Abstract 9229: Childhood Opportunity Level Predicts Early and Late Outcomes Following Surgery for Congenital Heart Disease

Abstract

Introduction: The multifaceted pathways through which a child’s environment impacts outcomes following congenital cardiac surgery remain incompletely characterized. Hypothesis: We hypothesized that childhood opportunity, measured using a US census-track-based, nationally-normed composite metric of contemporary neighborhood opportunity comprising 29 indicators across three domains (education, health or environment, and socioeconomic), would be a predictor of outcomes following congenital heart surgery. Methods: This was a single center, retrospective review of all patients who underwent congenital cardiac surgery from 01/2011-01/2020. Outcomes included pre-discharge (early) mortality, postoperative hospital length-of-stay (PHLOS), inpatient cost, post-discharge (late) mortality, and late unplanned reintervention. The primary predictor was child opportunity level (COL), categorized as very low, low, moderate, high, and very high. Associations were evaluated using multivariable logistic regression, generalized linear, Cox regression, or competing risk models. Results: Of 6133 patients, there were 124 (2.0%) early deaths, median PHLOS was 7 days (IQR 5-13 days), and median cost was $76,000 (IQR $50,000-$130,000). No significant association between COL and early mortality was noted (p=0.21). Children with very low and low COL had significantly longer hospitalizations and incurred higher costs compared to those with very high COL (all p<0.05). At up to 10.5 years of follow-up, very low COL patients had a significantly greater risk of late death (HR 1.7, 95% CI 1.1-2.6, p=0.030) and reintervention (SHR 1.9, 95% CI 1.5-2.3, p<0.001), versus those with very high COL ( Figure 1 ). Conclusions: Child opportunity is independently associated with outcomes following congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.