Child/Adolescent Health

Children's deaths after cardiac surgery seem mostly determined by age and the type of cardiac surgery

According to a new study, about 5 to 6 percent of children who undergo surgery for congenital heart disease die in the hospital, while less than 1 percent of children who are discharged after cardiac surgery die within a year. Younger children and those undergoing certain types of cardiac surgery are more at risk of dying within that year. Knowing which children have a greater risk of dying once they leave the hospital can prompt clinicians to follow them carefully to improve their outcomes, notes Ruey-Kang Chang, M.D., M.P.H., of the University of California Los Angeles Medical Center.

Using data from California between 1989 and 1999, Dr. Chang and colleagues examined 25,402 pediatric cardiac surgery cases with 1,505 in-hospital deaths. Of 23,897 hospital discharges, 148 deaths (0.62 percent) occurred within a year of discharge, including 37 deaths within 30 days. Young age was an important risk factor for postdischarge death. For example, neonates were nearly 5 times more likely and infants 3.5 times more likely to die after hospital discharge than children over 1 year old. Another significant risk factor was the type of cardiac procedure (23 types were studied). For example, children who underwent the Norwood operation (reconstruction of an absent or small aorta using the child's own pulmonary artery) were 8.4 times more likely to die within 30 days after discharge compared with children who underwent closure of ventricular septal defect.

Of the various surgical procedures, the Norwood operation was associated with the highest postdischarge death rate (6.77 percent), followed by aortopulmonary shunt with atrial septostomy (3.45 percent), repair of total anomalous pulmonary venous return (2.41 percent), truncus arteriosus repair (2.38 percent), and aortopulmonary shunt (2.13 percent). Other sociodemographic factors and hospital case volume were not significant predictors of postdischarge deaths. These findings were based on analysis of California hospital discharge data from 1989 to 1999, which the researchers linked to statewide death registry data. The study was supported in part by the Agency for Healthcare Research and Quality (HS13217).

More details are in "Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients," by Dr. Chang, Sandra Rodriguez, M.S., Maggie Lee, M.P.H., and Thomas S. Klitzner, M.D., Ph.D., in the American Heart Journal 152(2), pp. 386-393, 2006.

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