title: Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease.
abstract: BACKGROUND
  We sought to compare overall mortality with neonatal outcomes over a five year period to define risk factors for mortality and service development priorities.
  
  
  METHODS
  A retrospective cohort study of surgical outcomes following repair or palliation of structural congenital heart defects January 2005-2010. We defined mortality according to contemporary international guidelines and classified surgical procedures using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The effect of age and weight at operation on mortality and annual variation in case-complexity and surgeon case-mix were assessed. Subgroup analysis was performed in patients who were ≤30 days at operation (neonates).
  
  
  RESULTS
  Overall mortality within 30 days of operation or prior to hospital discharge was 1.3 and 1.9%, respectively. Mortality was higher in neonates (6.8%) and low birth weight infants (≤2.5kg) (12.1%). Mortality was similar in bypass versus non-bypass procedures (odds ratio 0.74, p=0.425). Annual mortality rates were consistent despite a marked increase in case-complexity. Neonates overall required longer periods of intensive care support and were more likely to suffer serious complications compared to older children. Age, weight and RACHS-1 score were independent risk factors for mortality on multivariate analysis. In neonates undergoing bypass procedures, only RACHS-1 score was a significant risk factor.
  
  
  CONCLUSIONS
  This study provides an accurate and contemporary audit of mortality risk associated with congenital heart surgery. Outcomes compare favourably to international benchmarks but highlight the risks of morbidity and mortality associated with neonatal cardiac surgery.
authors.affiliation: The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: James R
authors.initials: JR
authors.lastname: Padley
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Cole
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Pye
authors.forename: Richard B
authors.initials: RB
authors.lastname: Chard
authors.forename: Ian A
authors.initials: IA
authors.lastname: Nicholson
authors.forename: Stephen
authors.initials: S
authors.lastname: Jacobe
authors.forename: David
authors.initials: D
authors.lastname: Baines
authors.forename: Nadia
authors.initials: N
authors.lastname: Badawi
authors.forename: Karen
authors.initials: K
authors.lastname: Walker
authors.forename: Gabbie
authors.initials: G
authors.lastname: Scarfe
authors.forename: Karen
authors.initials: K
authors.lastname: Leclair
authors.forename: Gary F
authors.initials: GF
authors.lastname: Sholler
authors.forename: David S
authors.initials: DS
authors.lastname: Winlaw
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors