Congenital Heart Surgery Database Research Articles

Associations Between Unplanned Cardiac Reinterventions and Outcomes After Pediatric Cardiac Operations

After pediatric heart operations, we sought to determine the incidence of unplanned cardiac reinterventions during the same hospitalization, assess risk factors for these reinterventions, and explore associations between reinterventions and outcomes. We hypothesized that younger patients undergoing more complex operations would be at greater risk for unplanned cardiac reinterventions and that operative mortality and postoperative length of stay (PLOS) would be greater in patients who undergo reintervention than in those who do not. Patients aged 18 years or younger in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 2010 to June 2015) were included. We used multivariable regression to evaluate risk factors for unplanned cardiac reintervention (operation or therapeutic catheterization) and associations of reintervention with operative mortality and PLOS. Of 84,404 patients (117 centers), 21% were neonates and 36% infants. An unplanned cardiac reintervention was performed in 5.4% of patients, including 11.8% of neonates, 5.2% of infants, and 2.8% of children. Independent risk factors for unplanned reintervention included presence of noncardiac anomalies/genetic syndromes, nonwhite race, younger age, lower weight among neonates and infants, prior cardiothoracic operations, preoperative mechanical ventilation, other Society of Thoracic Surgeons preoperative risk factors, and higher Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery Mortality Category (adjusted p < 0.001 for all). Unplanned reintervention was a risk factor for operative mortality (adjusted odds ratio, 5.3; 95% confidence interval, 4.8 to 5.8; p < 0.001) and longer PLOS (adjusted relative risk, 2.3; 95% confidence interval, 2.2 to 2.4; p < 0.001). Unplanned cardiac reinterventions are not rare, particularly in neonates, and are independently associated with operative mortality and increased PLOS. Patients at greater risk may be identified preoperatively, presenting opportunities for quality improvement.

Evaluation of the Adult Congenital Heart Surgery Mortality Score at Two European Centers

The adult congenital heart surgery (ACHS) score was derived from The Society of Thoracic Surgeons Congenital Heart Surgery Database. The score was validated with data for 1,603 operations and reached a good predictive power. We sought to evaluate its predictive power for 1,654 operations performed in two European centers. Data of all consecutive patients aged 18 years or more who underwent surgery for congenital heart disease between 2004 and 2013 at center 1 (n= 830) and between 2005 and 2016 at center 2 (n= 824) were collected. Mortality was defined as hospital mortality or mortality within 30 days after surgery. The discriminatory power of the ACHS score was assessed using the area under the receiver-operating characteristics curve (c-index). During the examined 13-year period, 1,639 operations of 43 different procedural groups were eligible for scoring. The most frequent procedures were closure of atrial septal defect (n= 175, 10.7%), repair of partial anomalous pulmonary venous connection (n= 117, 7.1%), and aortic valve replacement (n= 112, 6.8%). Hospital mortality was 3.1%. The procedures with the highest mortality were heart transplantation (3 of 11, 27.3%), mitral valve replacement (9 of 39, 23.1%), and systemic venous stenosis repair (2 of 9, 22.2%). The c-index for the ACHS mortality score was 0.760 (0.750 in center 1 and 0.772 in center 2). The ACHS score reached similar, good predictive power in two different centers. The score is a useful tool to analyze surgical outcomes and to support individual decision making.

Invited Commentary

Invited Commentary

Invited Commentary

Invited Commentary

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2018 Update on Outcomes and Quality

The Society of Thoracic Surgeons Congenital Heart Surgery Database is a comprehensive registry of clinical outcomes that captures almost all pediatric cardiac surgical operations in the United States. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This article summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operation groups performed from January 2013 through December 2016. This analysis documents the overall aggregate Operative Mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.4%%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 2.0%); complete atrioventricular canal repair, 2.7% (0.0% to 4.4%); arterial switch operation, 2.2% (0.0% to 2.9%); arterial switch operation and ventricular septal defect repair, 5.1% (0.0% to 8.3%); Glenn/HemiFontan, 2.1% (0.0% to 3.1%); Fontan operation, 1.1% (0.0% to 0.0%); truncus arteriosus repair, 10.1% (0.0% to 15.4%); and Norwood procedure, 15.8% (9.0% to 25.0%).

Transitional Care for Young Adults With Congenital Heart Disease: A Case Study

Congenital heart defects, any of myriad innate problems with the structure and function of the heart, affect nearly 1% of births in the United States annually ( Centers for Disease Control and Prevention, 2016 Centers for Disease Control and Prevention Congenital heart defects: Data & statistics. Author, Atlanta, GA2016https://www.cdc.gov/ncbddd/heartdefects/data.html Google Scholar ). Historically, a congenital heart defect was regarded as an inevitable fatality. However, immense strides in diagnosis, operative techniques, and critical care over the past 60 years have increased an infant's chance of survival into adulthood to 85% to 90% ( Gurvitz et al, 2016 Gurvitz M. Burns K.M. Brindis R. Broberg C.S. Daniels C.J. Fuller S.M. Califf R.M. Emerging research directions in adult congenital heart disease: A report from an NHLBI/ACHA Working Group. Journal of the American College of Cardiology. 2016; 67: 1956-1964 Crossref PubMed Scopus (65) Google Scholar ). In fact, adults account for two-thirds of the overall congenital heart disease (CHD) population ( Jacobs et al, 2015 Jacobs J.P. Mavroudis C. Quintessenza J.A. Chai P.J. Pasquali S.K. Hill K.D. Cameron D. Reoperations for pediatric and congenital heart disease: An analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database. Seminars in Thoracic and Cardiovascular Surgery Journal. 2015; 17: 2-8 Google Scholar ). This transition from mortality to vitality is an epic achievement, but it is not lacking in controversy. On the contrary, adult CHD poses very unique challenges to patients and health care providers alike. Most prominent is the ambiguity surrounding which providers should follow adult patients with pediatric heart conditions. The following case elucidates the nature of this novel dilemma, leading to a discussion of the critical role of the pediatric nurse practitioner (PNP) in the transition of care as children with CHD become adults. Adult CHD poses very unique challenges to patients and health care providers alike. Adult CHD poses very unique challenges to patients and health care providers alike. Jenna A. Larson, Pediatric Nurse Practitioner, Pediatric Emergency Department, MassGeneral for Children at North Shore Medical Center, Salem, MA; and Recent Graduate, Pediatric Nurse Practitioner Program, Yale School of Nursing, West Haven, CT. Elizabeth A. Doyle, Assistant Professor, Yale School of Nursing, West Haven, CT; and Advanced Practice Registered Nurse/Certified Diabetes Educator, Yale Diabetes Center, Yale–New Haven Hospital, New Haven, CT.

Hybrid Palliation: Outcomes After the Comprehensive Stage 2 Procedure

The comprehensive stage 2 procedure (CS2) follows initial hybrid stage 1 palliation for patients with single-ventricle physiology. The goal of this study was to describe CS2 outcomes and differences between survivors of CS2 (s-CS2) and nonsurvivors (nons-CS2). All patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent CS2 as index operation from 2010 to 2016 were included. Preoperative, operative, and postoperative data were analyzed, stratified by operative mortality (in-hospital or within 30 days of the operation), with univariate comparisons using χ2, Fisher exact, or Wilcoxon rank sum tests. Of 209 patients (49 centers) who met inclusion criteria, 141 patients had the diagnosis of hypoplastic left heart syndrome. Overall operative mortality was 12.4% (26 of 209). s-CS2 had a lower prevalence of preoperative extracorporeal membrane oxygenation use (0.0% vs 7.7%, p= 0.02) and less frequently underwent concomitant tricuspid valve procedures at the time of the operation (1.1% vs 11.5%, p= 0.01) than nons-CS2. Postoperatively, the prevalence of any of six The Society of Thoracic Surgeons Congenital Heart Surgery Database major complications was higher in nons-CS2 than in s-CS2 (53.9% vs 23.0%, p < 0.01), including a higher prevalence of renal failure (7.7% vs 0.6%, p= 0.04) and postoperative extracorporeal membrane oxygenation use (46.2% vs 2.7%, p < 0.01). There were no other preoperative, operative, or postoperative differences between the two groups. Operative mortality associated with the CS2 procedure is substantial, especially for patients receiving extracorporeal membrane oxygenation support after CS2. No obvious modifiable variables were noted between patients who died and those who survived.

The Society of Thoracic Surgeons National Database 2017 Annual Report

The Society of Thoracic Surgeons (STS) National Database has three major component databases: the STSAdult Cardiac Surgery Database (ACSD), the STS Congenital Heart Surgery Database (CHSD), and the STS General Thoracic Surgery Database (GTSD). Beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article summarizes the status of the STS National Database as of October 2017 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2017 series "Outcomes Analysis, Quality Improvement, and Patient Safety."

Shunt Failure—Risk Factors and Outcomes: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Systemic-to-pulmonary shunt failure is a potentially catastrophic complication. We analyzed a large multicenter clinical registry to describe the prevalence and evaluate risk factors. Infants (aged ≤365 days) undergoing shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2010 to 2015 were included. Multivariable logistic regression was used to evaluate risk factors for in-hospital shunt failure. Model covariates included patient characteristics, preoperative factors, procedural factors including shunt type, and center effects. Centers with more than 15% missing data for key covariates were excluded. Shunt operations were performed in 9,172 infants (118 centers). In-hospital shunt failure occurred in 674 (7.3%). In multivariable analysis, risk factors for in-hospital shunt failure included lower weight at operation (odds ratio [OR], 1.35; p= 0.001), preoperative hypercoagulable state (OR, 2.47; p= 0.031), and the presence of any other STS-CHSD preoperative risk factors (OR, 1.24; p= 0.038). Shunt failure was less likely with a systemic ventricle-to-pulmonary artery shunt than a systemic artery-to-pulmonary artery shunt (OR, 0.65; p= 0.020). Neither cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor for shunt failure. Patients with in-hospital shunt failure had significantly higher rates of operative mortality (31.9% vs 11.1%, p<0.001) and major morbidity (84.4% vs 29.4%, p < 0.001), and longer median postoperative length of stay among survivors (45 vs 22 days, p < 0.001). In-hospital shunt failure is common, and associated mortality risk is high. These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance and may benefit from enhanced antithrombotic prophylaxis or other management strategies to reduce shunt failure. These findings may inform planning of future clinical trials.

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 Update on Research

The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It contains data pertaining to more than 435,000 total operations. The most recent biannual feedback report to participants (Spring 2017, Report of the Twenty-Sixth Harvest) included analysis of data submitted from 127 hospitals in North America. That represents nearly all centers performing pediatric and congenital heart operations in the United States and Canada. As an unparalleled platform for assessment of outcomes and for quality improvement activities in the subspecialty of surgery for pediatric and congenital heart disease, the STS CHSD continues to be a primary data source for clinical investigations and for research and innovations related to quality measurement. In 2016, several major original publications reported analyses of data in the CHSD pertaining to various processes of care, including assessment of variation across centers and associations between specific practices, patient characteristics, and outcomes. Additional publications reported the most recent development, evaluation, and application of metrics for quality measurement and reporting of pediatric and congenital heart operation outcomes and center level performance. Use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation has grown to include nearly all centers in North America, and the available wealth of data in the database continues to grow. This article reviews outcomes research and quality improvement articles published in 2016 that are based on STS CHSD data.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Influence of weight at the time of first palliation on survival in patients with a single ventricle

Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution. We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected. A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure. Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data From the Society of Thoracic Surgeons Database.

Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated. A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression. Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome. Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.

Fifty-Third Annual Meeting, The Society of Thoracic Surgeons

Fifty-Third Annual Meeting, The Society of Thoracic Surgeons

Duration of Mechanical Ventilation and Perioperative Care Quality After Neonatal Cardiac Operations

This study was conducted to determine whether the duration of mechanical ventilation (DOMV) could be used to benchmark the overall quality of care after neonatal congenital heart operations. Children aged younger than 30 days undergoing cardiac operations were reviewed. Technical adequacy was assessed using the Technical Performance Score (TPS), a previously validated tool for determining the adequacy of a palliative or corrective surgical procedure that uses echocardiography criteria and need for unplanned reintervention to determine technical adequacy. Preoperative risk factors and postoperative complications were determined using The Society of Thoracic Surgeons Congenital Heart Surgery Database definitions. Surgical complexity was assessed using The Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery (STAT) Mortality Categories. We explored associations between preoperative risk factors, STAT category, TPS, and postoperative complications with DOMV. Of 601 patients studied, 49 were not included in the multivariable analysis due to a STAT nonclassifiable operation or unmeasured TPS, or both. Multiple risk factors were associated with longer DOMV, including weight (p= 0.005), The Society of Thoracic Surgeons Congenital Heart Surgery Database preoperative factors (p= 0.005), STAT mortality category (p < 0.001), TPS (p < 0.001), and The Society of Thoracic Surgeons Congenital Heart Surgery Database-defined complications (p < 0.001). Multivariable regression showed that preoperative factors increased DOMV by 1.23 days (p= 0.01), class 3 TPS by 2.16 days (p < 0.001), and postoperative complications by 2.03 days (p < 0.001), with adjusted R2= 0.42. Neonates with major residual lesions and postoperative complications have prolonged DOMV. DOMV may reflect the quality of care after congenital heart operations.

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 Update on Outcomes and Quality

The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This report summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2012 to December 2015. This analysis documents the overall aggregate operative mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.8%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 1.4%); complete atrioventricular canal repair, 3.0% (0.0% to 4.7%); arterial switch operation, 2.7% (0.0% to 4.1%); arterial switch operation and ventricular septal defect repair, 5.3% (0.0% to 6.7%); Glenn/hemi-Fontan, 2.5% (0.0% to 4.5%); Fontan operation, 1.2% (0.0% to 1.2%); truncus arteriosus repair, 9.4% (0.0% to 16.7%); and Norwood procedure, 15.7% (8.9% to 25.0%).

Morbidity and mortality prediction in pediatric heart surgery: Physiological profiles and surgical complexity

ObjectivesOutcome prediction for pediatric heart surgery has focused on mortality but mortality has been significantly reduced over the past 2 decades. Clinical care practices now emphasize reducing morbidity. Physiology-based profiles assessed by the Pediatric Risk of Mortality (PRISM) score are associated with new significant functional morbidity detected at hospital discharge. Our aims were to assess the relationship between new functional morbidity and surgical risk categories (Risk Adjustment for Congenital Heart Surgery [RACHS] and Society for Thoracic Surgery Congenital Heart Surgery Database Mortality Risk [STAT]), measure the performance of 3-level (intact survival, survival with new functional morbidity, or death) and 2-level (survival or death) PRISM prediction algorithms, and assess whether including RACHS or STAT complexity categories improves the PRISM predictive performance. MethodsPatients (newborn to age 18 years) were randomly selected from 7 sites (December 2011-April 2013). Morbidity (using the Functional Status Scale) and mortality were assessed at hospital discharge. The most recently published PRISM algorithms were tested for goodness of fit, and discrimination with and without the RACHS and STAT complexity categories. ResultsThe mortality rate in the 1550 patients was 3.2%. Significant new functional morbidity rate occurred in 4.8%, increasing from 1.8% to 13.9%, 1.7%, and 12.9% from the lowest to the highest RACHS and STAT categories, respectively. The 3-level and 2-level PRISM models had satisfactory goodness of fit and substantial discriminative ability. Inclusion of RACHS and STAT complexity categories did not improve model performance. ConclusionsBoth mortality and new, functional morbidity are important outcomes associated with surgical complexity and can be predicted using PRISM algorithms. Adding surgical complexity to the physiologic profiles does not improve predictor performance.

The Society of Thoracic Surgeons Congenital Heart Surgery Database Public Reporting Initiative.

Three basic principles provide the rationale for the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) public reporting initiative: (1) Variation in congenital and pediatric cardiac surgical outcomes exist. (2) Patients and their families have the right to know the outcomes of the treatments that they will receive. (3). It is our professional responsibility to share this information with them in a format they can understand. The STS CHSD public reporting initiative facilitates the voluntary transparent public reporting of congenital and pediatric cardiac surgical outcomes using the STS CHSD Mortality Risk Model. The STS CHSD Mortality Risk Model is used to calculate risk-adjusted operative mortality and adjusts for the following variables: age, primary procedure, weight (neonates and infants), prior cardiothoracic operations, non-cardiac congenital anatomic abnormalities, chromosomal abnormalities or syndromes, prematurity (neonates and infants), and preoperative factors (including preoperative/preprocedural mechanical circulatory support [intraaortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation, or cardiopulmonary support], shock [persistent at time of surgery], mechanical ventilation to treat cardiorespiratory failure, renal failure requiring dialysis and/or renal dysfunction, preoperative neurological deficit, and other preoperative factors). Operative mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30th postoperative day. The STS CHSD Mortality Risk Model has good model fit and discrimination with an overall C statistics of 0.875 and 0.858 in the development sample and the validation sample, respectively. These C statistics are the highest C statistics ever seen in a pediatric cardiac surgical risk model. Therefore, the STS CHSD Mortality Risk Model provides excellent adjustment for case mix and should mitigate against risk aversive behavior. The STS CHSD Mortality Risk Model is the best available model to date for measuring outcomes after pediatric cardiac surgery. As of March 2016, 60% of participants in STS CHSD have agreed to publicly report their outcomes through the STS Public Reporting Online website (http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online). Although several opportunities exist to improve our risk models, the current STS CHSD public reporting initiative provides the tools to report publicly, and with meaning and accuracy, the outcomes of congenital and pediatric cardiac surgery.

Abstract 12201: Infants With 22q11.2 Deletion Syndrome Undergoing Repair of Tetralogy of Fallot, Interrupted Aortic Arch, and Truncus Arteriosus have Longer Hospitalizations and Increased Rates of Infection

Introduction: 22q11.2 deletion syndrome (22q11del) is common in patients with certain types of congenital heart disease. The prevalence of 22q11del and its impact on clinical outcomes remains unclear as only small single center studies are available and have shown conflicting data. Methods: All infants with tetralogy of Fallot (TOF), truncus arteriosus (TA), interrupted aortic arch (IAA), or IAA+TA included in the STS Congenital Heart Surgery Database from 1/10 to 6/15 were included. Infants with single ventricle lesions, pulmonary atresia with MAPCAs, and trisomies were excluded. Perioperative mortality and STS-defined major morbidities were compared between patients with and without 22q11del. Analyses were performed using Wilcoxon rank sum or chi-square tests. Results: A total of 5,179 patients were included. 22q11del was present in 255 (6.3%) patients with TOF, 160 (28.8%) with TA, 206 (38.4%) with IAA, and 19 (28.8%) with IAA+TA undergoing repair. For all procedural cohorts, there was no significant difference in perioperative mortality between the two groups. Infants with 22q11del had a longer hospitalization and a higher incidence of postoperative infections (Table). Within the TOF cohort only, infants with 22q11del had a higher incidence of the STS-defined composite major morbidity measure (12.5% vs. 6.1%, p&lt;0.01), largely driven by an increased incidence of unplanned re-interventions (9.9% vs. 4.3%, p&lt;0.01) and phrenic nerve injuries (2.5% vs. 0.8%, p=0.01). Conclusions: 22q11del is common in infants undergoing repair of TOF, TA, IAA, and IAA+TA. While operative mortality for the diagnostic groups was not impacted by 22q11del, patients with 22q11del did have longer hospitalizations and a higher incidence of infectious complications. Families should be counseled appropriately and further strategies should be developed to limit the morbidity in patients with 22q11del undergoing congenital heart surgery.

Abstract 13013: Associations Between Unplanned Cardiac Reinterventions and Early Outcomes After Pediatric Cardiac Surgery: Findings From the Society of Thoracic Surgeons Congenital Heart Surgery Database

Introduction: In children undergoing cardiac surgery, we sought to determine the incidence of unplanned cardiac reinterventions (surgery or therapeutic catheterization) during the same hospitalization as the index operation, identify risk factors for reinterventions, and explore associations between unplanned reinterventions and adverse outcomes. Hypothesis: We hypothesized that younger patients undergoing more complex operations would be at greater risk for unplanned cardiac reinterventions, and that operative mortality and postoperative length of stay (LOS) would be greater in patients who undergo reintervention when compared to those who do not. Methods: Patients ≤18 years of age in the STS Congenital Heart Surgery Database from January 2010-June 2015 were included. Multivariable logistic regression was used to evaluate risk factors for unplanned reintervention, and the impact of reintervention on outcomes including operative mortality and post-operative LOS. Covariates were included to adjust for important patient characteristics (e.g., weight, age, and comorbidities), case complexity, and center effects. Results: Included were 84,404 patients from 117 centers, of whom 21% were neonates and 36% infants. An unplanned cardiac reintervention was performed in 5.4% of patients, including 11.8% of neonates, 5.2% of infants, and 2.8% of children. Independent risk factors for an unplanned reintervention included presence of non-cardiac anomalies and genetic syndromes, non-Caucasian race, younger age, lower weight among neonates and infants, prior cardiothoracic operations, preoperative mechanical ventilation, preoperative risk factors, and higher STAT Mortality Category (adjusted p&lt;0.001 for all). The performance of an unplanned reintervention was an independent risk factor for operative mortality (adjusted OR, 5.34, 95% CI, 4.83-5.91, p&lt;0.001) and longer post-operative LOS (adjusted RR=2.31, 95% CI, 2.20-2.42, p&lt;0.001). Conclusions: Unplanned cardiac reinterventions are not rare, particularly in neonates, and are independently associated with mortality and increased post-operative LOS. Patients at greater risk may be readily identified preoperatively, presenting opportunities for quality improvement.