Complications after the Norwood operation

An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Christoph P. Hornik, Xia He, Jeffrey P. Jacobs, Jennifer S. Li, Robert D B Jaquiss, Marshall L. Jacobs, Sean M. O'Brien, Eric D. Peterson, Sara K. Pasquali

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Limited multicenter data exist regarding the prevalence of postoperative complications after the Norwood operation and their associated mortality risk. Methods: We evaluated infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent the Norwood operation from 2000 to 2009. The prevalence of postoperative complications after the Norwood operation and associated in-hospital mortality were described. Patient factors associated with complications were evaluated in multivariable analyses. Results: A total of 2,557 patients from 53 centers were included. Median age at operation was 6 days (interquartile range, 4 to 9 days) and 90% had a right dominant ventricle. Overall mortality was 22%, and 75% had 1 complication or more. Mortality increased with increasing number of complications: 1 complication, 17%; 2 complications, 21%; 3 complications, 26%; 4 complications, 33%; and 5 or more complications, 45%. Renal and cardiovascular complications carried the greatest mortality risk. Patient factors associated with 1 complication or more included weight less than 2.5 kg (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), single right versus single left ventricle (OR, 1.4; 95% CI, 1.01 to 2.0), preoperative shock (OR, 1.5; 95% CI, 1.1 to 2.1), noncardiac/genetic abnormality (OR, 1.5; 95% CI, 1.2 to 1.9), and preoperative mechanical ventilatory (OR, 1.3; 95% CI, 1.03 to 1.6) or circulatory (OR 4.0; 95%CI, 1.6 to 10.2) support. Conclusions: Complications after the Norwood operation are common, carry significant mortality risk, and are associated with several preoperative patient characteristics. These data may aid in providing prognostic information to families and in guiding quality improvement initiatives.

Original languageEnglish (US)
Pages (from-to)1734-1740
Number of pages7
JournalAnnals of Thoracic Surgery
Volume92
Issue number5
DOIs
StatePublished - Nov 1 2011

Fingerprint

Norwood Procedures
Thoracic Surgery
Odds Ratio
Databases
Confidence Intervals
Mortality
Heart Ventricles
Quality Improvement
Hospital Mortality
Shock
Kidney
Weights and Measures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Complications after the Norwood operation : An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. / Hornik, Christoph P.; He, Xia; Jacobs, Jeffrey P.; Li, Jennifer S.; Jaquiss, Robert D B; Jacobs, Marshall L.; O'Brien, Sean M.; Peterson, Eric D.; Pasquali, Sara K.

In: Annals of Thoracic Surgery, Vol. 92, No. 5, 01.11.2011, p. 1734-1740.

Research output: Contribution to journalArticle

Hornik, Christoph P. ; He, Xia ; Jacobs, Jeffrey P. ; Li, Jennifer S. ; Jaquiss, Robert D B ; Jacobs, Marshall L. ; O'Brien, Sean M. ; Peterson, Eric D. ; Pasquali, Sara K. / Complications after the Norwood operation : An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 5. pp. 1734-1740.
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abstract = "Background: Limited multicenter data exist regarding the prevalence of postoperative complications after the Norwood operation and their associated mortality risk. Methods: We evaluated infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent the Norwood operation from 2000 to 2009. The prevalence of postoperative complications after the Norwood operation and associated in-hospital mortality were described. Patient factors associated with complications were evaluated in multivariable analyses. Results: A total of 2,557 patients from 53 centers were included. Median age at operation was 6 days (interquartile range, 4 to 9 days) and 90{\%} had a right dominant ventricle. Overall mortality was 22{\%}, and 75{\%} had 1 complication or more. Mortality increased with increasing number of complications: 1 complication, 17{\%}; 2 complications, 21{\%}; 3 complications, 26{\%}; 4 complications, 33{\%}; and 5 or more complications, 45{\%}. Renal and cardiovascular complications carried the greatest mortality risk. Patient factors associated with 1 complication or more included weight less than 2.5 kg (odds ratio [OR], 1.6; 95{\%} confidence interval [CI], 1.2 to 2.1), single right versus single left ventricle (OR, 1.4; 95{\%} CI, 1.01 to 2.0), preoperative shock (OR, 1.5; 95{\%} CI, 1.1 to 2.1), noncardiac/genetic abnormality (OR, 1.5; 95{\%} CI, 1.2 to 1.9), and preoperative mechanical ventilatory (OR, 1.3; 95{\%} CI, 1.03 to 1.6) or circulatory (OR 4.0; 95{\%}CI, 1.6 to 10.2) support. Conclusions: Complications after the Norwood operation are common, carry significant mortality risk, and are associated with several preoperative patient characteristics. These data may aid in providing prognostic information to families and in guiding quality improvement initiatives.",
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T2 - An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

AU - Hornik, Christoph P.

AU - He, Xia

AU - Jacobs, Jeffrey P.

AU - Li, Jennifer S.

AU - Jaquiss, Robert D B

AU - Jacobs, Marshall L.

AU - O'Brien, Sean M.

AU - Peterson, Eric D.

AU - Pasquali, Sara K.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Background: Limited multicenter data exist regarding the prevalence of postoperative complications after the Norwood operation and their associated mortality risk. Methods: We evaluated infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent the Norwood operation from 2000 to 2009. The prevalence of postoperative complications after the Norwood operation and associated in-hospital mortality were described. Patient factors associated with complications were evaluated in multivariable analyses. Results: A total of 2,557 patients from 53 centers were included. Median age at operation was 6 days (interquartile range, 4 to 9 days) and 90% had a right dominant ventricle. Overall mortality was 22%, and 75% had 1 complication or more. Mortality increased with increasing number of complications: 1 complication, 17%; 2 complications, 21%; 3 complications, 26%; 4 complications, 33%; and 5 or more complications, 45%. Renal and cardiovascular complications carried the greatest mortality risk. Patient factors associated with 1 complication or more included weight less than 2.5 kg (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), single right versus single left ventricle (OR, 1.4; 95% CI, 1.01 to 2.0), preoperative shock (OR, 1.5; 95% CI, 1.1 to 2.1), noncardiac/genetic abnormality (OR, 1.5; 95% CI, 1.2 to 1.9), and preoperative mechanical ventilatory (OR, 1.3; 95% CI, 1.03 to 1.6) or circulatory (OR 4.0; 95%CI, 1.6 to 10.2) support. Conclusions: Complications after the Norwood operation are common, carry significant mortality risk, and are associated with several preoperative patient characteristics. These data may aid in providing prognostic information to families and in guiding quality improvement initiatives.

AB - Background: Limited multicenter data exist regarding the prevalence of postoperative complications after the Norwood operation and their associated mortality risk. Methods: We evaluated infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent the Norwood operation from 2000 to 2009. The prevalence of postoperative complications after the Norwood operation and associated in-hospital mortality were described. Patient factors associated with complications were evaluated in multivariable analyses. Results: A total of 2,557 patients from 53 centers were included. Median age at operation was 6 days (interquartile range, 4 to 9 days) and 90% had a right dominant ventricle. Overall mortality was 22%, and 75% had 1 complication or more. Mortality increased with increasing number of complications: 1 complication, 17%; 2 complications, 21%; 3 complications, 26%; 4 complications, 33%; and 5 or more complications, 45%. Renal and cardiovascular complications carried the greatest mortality risk. Patient factors associated with 1 complication or more included weight less than 2.5 kg (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), single right versus single left ventricle (OR, 1.4; 95% CI, 1.01 to 2.0), preoperative shock (OR, 1.5; 95% CI, 1.1 to 2.1), noncardiac/genetic abnormality (OR, 1.5; 95% CI, 1.2 to 1.9), and preoperative mechanical ventilatory (OR, 1.3; 95% CI, 1.03 to 1.6) or circulatory (OR 4.0; 95%CI, 1.6 to 10.2) support. Conclusions: Complications after the Norwood operation are common, carry significant mortality risk, and are associated with several preoperative patient characteristics. These data may aid in providing prognostic information to families and in guiding quality improvement initiatives.

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