Impact of Intrauterine Growth Restriction on Cardiac Surgical Outcomes and Resource Use

Abstract

We sought to evaluate outcomes of congenital heart operations and resource use in patients with intrauterine growth restriction (IUGR). This was a retrospective matched case-control study of 41 consecutive patients with IUGR matched 1:2 with a comparison cohort of 82 contemporaneous patients without IUGR who underwent congenital heart operations during the interval from January 1, 2000 to January 1, 2012. Matching was based on the Risk Adjustment for Congenital Heart Surgery (RACHS)-1 risk category, diagnostic category, age at operation, and gestational age. Operative mortality (6 of 41 cases [14.6%] for the study group versus 5 of 82 cases [6.1%] for controls) and any major adverse event (14 of 41 cases [34.2%] for the study group versus 23 of 82 cases [28%] for controls) occurred in a higher percentage of study patients, with insignificant p values. Important differences in secondary outcomes included the following: mean total length of stay (56.3 days versus 28.0 days for controls; p < 0.0001), postoperative days of mechanical ventilation (25.8 days versus 5.4 days for controls; p = 0.002), postoperative cardiopulmonary arrest (7 of 41 cases [17.1%] versus 4 of 82 cases [4.9%] for controls; p = 0.03), and postoperative infection (13 of 41 cases [31.7%] versus 13 of 81 cases [16.1%] for controls; p = 0.04). The mean charge for the study group was considerably higher than that for the control group: $493,915 versus $175,144; p < 0.0001. IUGR is associated with a substantially increased length of hospital stay, postoperative morbidity, and resource use. These findings are relevant to risk stratification, prognosis, and potentially to contracting and reimbursement. IUGR merits further attention as an important risk factor in congenital heart operations.