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<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<0.001) and longer post-operative LOS (adjusted RR=2.31, 95% CI, 2.20-2.42, p<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.