Cardiac surgery in adults performed at children's hospitals: Trends and outcomes

Abstract

The number of adults with congenital heart disease who require cardiac surgery is projected to increase dramatically. Controversy exists as to whether such procedures should be performed in pediatric centers, which generally have the greatest experience with operations for congenital heart disease. We sought to report the outcomes for cardiac surgery performed in adults (>or=21 years of age) at children's hospitals and determine how these practices varied among institutions. Data from July 2005 to June 2007 from the Child Health Corporation of America, a consortium of 37 free-standing children's hospitals, were analyzed to determine the institutional volume, type of cardiac procedure, outcome, and hospital charges. Individual institutional variables were analyzed to determine which factors might be associated with the practice of performing adult cardiac surgery in children's hospitals. During the study period, there were 719 admissions for cardiac surgery in adults at Child Health Corporation of America institutions. The median age at the time of operation was 26 years (range, 21-86 years). The most common surgical procedures were implantation or revision of a pacemaker or defibrillator (n = 207 [29.2%]), pulmonary valve replacement (n = 119 [16.8%]), aortic valve replacement (n = 59 [8.3%]), and Fontan revision (n = 37 [5.2%]). The median hospital length of stay was 6 days (range, 1-175 days). The hospital mortality was 1.9%. Comorbid conditions likely to require other subspecialty care were present in more than 30% of patients. Among the Child Health Corporation of America centers, adult operations as a proportion of overall cardiac operations varied from 0% to 10.9%. There was no relationship between overall cardiac surgical volume and proportion of adult cases performed in Child Health Corporation of America centers. A significant number of adult cardiac surgical procedures are being performed at children's hospitals with excellent results. The majority of procedures are not related to complex shunt lesions but rather pacemaker/defibrillator implantation and semilunar valve surgery. Whether adult patients with congenital heart disease should continue to undergo most cardiac surgery in children's hospitals is worthy of discussion.