Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial

Sarah Tabbutt, Nancy Ghanayem, Chitra Ravishankar, Lynn A. Sleeper, David S. Cooper, Deborah U. Frank, Minmin Lu, Christian Pizarro, Peter Frommelt, Caren S. Goldberg, Eric M. Graham, Catherine Dent Krawczeski, Wyman W. Lai, Alan Lewis, Joel A. Kirsh, Lynn Mahony, Richard G. Ohye, Janet Simsic, Andrew J. Lodge, Ellen SpurrierMario Stylianou, Peter Laussen

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Objectives: We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Methods: Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Results: Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Conclusions: Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.

Original languageEnglish (US)
Pages (from-to)882-895
Number of pages14
JournalJournal of Thoracic and Cardiovascular Surgery
Volume144
Issue number4
DOIs
StatePublished - Oct 2012

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Norwood Procedures
Hospital Mortality
Pediatrics
Morbidity
Sternum
Length of Stay
Mortality
Extracorporeal Membrane Oxygenation
Ventilation
Hospitalization
Deep Hypothermia Induced Circulatory Arrest
Hypoplastic Left Heart Syndrome
Birth Weight
Heart Ventricles
Renal Insufficiency
Survivors
Sepsis
Regression Analysis
Newborn Infant

ASJC Scopus subject areas

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

Cite this

Risk factors for hospital morbidity and mortality after the Norwood procedure : A report from the Pediatric Heart Network Single Ventricle Reconstruction trial. / Tabbutt, Sarah; Ghanayem, Nancy; Ravishankar, Chitra; Sleeper, Lynn A.; Cooper, David S.; Frank, Deborah U.; Lu, Minmin; Pizarro, Christian; Frommelt, Peter; Goldberg, Caren S.; Graham, Eric M.; Krawczeski, Catherine Dent; Lai, Wyman W.; Lewis, Alan; Kirsh, Joel A.; Mahony, Lynn; Ohye, Richard G.; Simsic, Janet; Lodge, Andrew J.; Spurrier, Ellen; Stylianou, Mario; Laussen, Peter.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 144, No. 4, 10.2012, p. 882-895.

Research output: Contribution to journalArticle

Tabbutt, S, Ghanayem, N, Ravishankar, C, Sleeper, LA, Cooper, DS, Frank, DU, Lu, M, Pizarro, C, Frommelt, P, Goldberg, CS, Graham, EM, Krawczeski, CD, Lai, WW, Lewis, A, Kirsh, JA, Mahony, L, Ohye, RG, Simsic, J, Lodge, AJ, Spurrier, E, Stylianou, M & Laussen, P 2012, 'Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial', Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 4, pp. 882-895. https://doi.org/10.1016/j.jtcvs.2012.05.019
Tabbutt, Sarah ; Ghanayem, Nancy ; Ravishankar, Chitra ; Sleeper, Lynn A. ; Cooper, David S. ; Frank, Deborah U. ; Lu, Minmin ; Pizarro, Christian ; Frommelt, Peter ; Goldberg, Caren S. ; Graham, Eric M. ; Krawczeski, Catherine Dent ; Lai, Wyman W. ; Lewis, Alan ; Kirsh, Joel A. ; Mahony, Lynn ; Ohye, Richard G. ; Simsic, Janet ; Lodge, Andrew J. ; Spurrier, Ellen ; Stylianou, Mario ; Laussen, Peter. / Risk factors for hospital morbidity and mortality after the Norwood procedure : A report from the Pediatric Heart Network Single Ventricle Reconstruction trial. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 144, No. 4. pp. 882-895.
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T1 - Risk factors for hospital morbidity and mortality after the Norwood procedure

T2 - A report from the Pediatric Heart Network Single Ventricle Reconstruction trial

AU - Tabbutt, Sarah

AU - Ghanayem, Nancy

AU - Ravishankar, Chitra

AU - Sleeper, Lynn A.

AU - Cooper, David S.

AU - Frank, Deborah U.

AU - Lu, Minmin

AU - Pizarro, Christian

AU - Frommelt, Peter

AU - Goldberg, Caren S.

AU - Graham, Eric M.

AU - Krawczeski, Catherine Dent

AU - Lai, Wyman W.

AU - Lewis, Alan

AU - Kirsh, Joel A.

AU - Mahony, Lynn

AU - Ohye, Richard G.

AU - Simsic, Janet

AU - Lodge, Andrew J.

AU - Spurrier, Ellen

AU - Stylianou, Mario

AU - Laussen, Peter

PY - 2012/10

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N2 - Objectives: We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Methods: Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Results: Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Conclusions: Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.

AB - Objectives: We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Methods: Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Results: Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Conclusions: Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.

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