Unplanned reinterventions after congenital cardiac surgery and hospital mortality: A report from the Pediatric Cardiac Critical Care Consortium (PC4).

Abstract

Objectives: Unplanned cardiac reinterventions after congenital cardiac surgery may complicate the postoperative course. We sought to identify incidence rates and risk factors for unplanned cardiac reinterventions and associations between unplanned cardiac reinterventions and hospital mortality.

Methods: Patients in the Pediatric Cardiac Critical Care Consortium registry undergoing an index cardiac operation from February 2019 to January 2022 were included. Multivariable logistic regression, adjusted for center effect, was used to evaluate patient risk factors for unplanned cardiac reinterventions and the impact of reintervention on hospital mortality.

Results: Included were 34,495 patients from 62 centers. Unplanned cardiac reinterventions occurred in 2635 patients (7.6%) with wide center variation. Risk factors for unplanned cardiac reinterventions included Black race, extracardiac and chromosomal anomalies, younger age, lower weight for age, prior cardiac surgeries, and higher surgical complexity category. The performance of an unplanned cardiac reintervention was associated with higher hospital mortality (16.1%) compared with those who did not undergo reintervention (1.3%) (adjusted odds ratio, 6.45; 95% CI, 5.51-7.56, P < .001). The odds of mortality after unplanned cardiac reinterventions increased with higher Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery category. Mortality was highest in patients who underwent both reoperation and interventional catheterization (31.9%) compared with those who underwent only reoperation (16.3%) or catheterization (9.8%).

Conclusions: Unplanned cardiac reinterventions occur in approximately 1 in 13 patients after congenital cardiac surgery, and approximately 1 in 6 patients with an unplanned cardiac reintervention will die. Patients at greatest risk for unplanned cardiac reinterventions may share patient and disease-specific risk factors. Further investigation is needed to minimize the incidence of residual lesions, understand why Black children have more unplanned cardiac reinterventions, and explore modifiable risk factors for and optimal timing of unplanned cardiac reinterventions.