Serban Stoica
Children’s Hospital and the Heart Institute, UK
Title: Early reoperations in a 5-year national cohort of congenital heart disease patients
Biography
Biography: Serban Stoica
Abstract
OBJECTIVE: 1. To determine the quantitative burden of early congenital reoperations; 2. to evaluate if reoperation within the first 30 days is a suitable metric of quality of care.
METHODS: Anonymised data on early reoperations were extracted from the UK National Institute for Cardiovascular Outcomes Research (NICOR) for 2005-2010.
RESULTS: 19239 procedures were identified in 15552 patients. During data cleaning 723 reoperations were excluded (3.8%) and the remainder were adjudicated to predefined categories. 676 early reoperations (3.5%) were recorded in 593 patients, ranging from 1-7/patient (median 1/patient). Cases included/excluded and their prevalence are shown below (Table). The cases excluded a priori are likely under-represented as practices vary between centres (e.g. for reopening) and for submitting minor procedures data to NICOR. There are many complex scenarios where surgical teams choose operative adjustment (e. g. in palliative procedures) or planned/complex operative sequences to mitigate survival. For retained patients the median age and weight were 4.0 kg and 0.19 years and18.2% of them were readmitted for reoperation. Independent risk factors were sought by multivariate analysis. The most common reoperations were in patients palliated by shunting.
CONCLUSIONS: Reoperations within 30-days are infrequent. Those that can be accurately included in a retrospective analysis are no more prevalent than death (3.2%). ‘Unplanned’ reoperation is a misnomer as only a minority can be classified as such. Prospective studies are under way to establish the definitions and true prevalence of reoperations. Until these studies are completed, inclusion of unplanned surgery on quality of care dashboards is debatable.