title: Center variation in patient age and weight at Fontan operation and impact on postoperative outcomes.
abstract: BACKGROUND
  The impact of age and weight on outcomes after the Fontan operation is unclear. Previous analyses have suggested that lower weight-for-age z-score is an important predictor of poor outcome in patients undergoing bidirectional Glenn. We evaluated variation in age, weight, and weight-for-age z-score at Fontan across institutions, and the impact of these variables on postoperative morbidity and mortality.
  
  
  METHODS
  Patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000 to 2009) were included. Center variation in age, weight, and weight-for-age z-score were described. Multivariable analysis was performed to evaluate the impact of age, weight, and weight-for-age z-score on in-hospital mortality, Fontan failure (combined in-hospital mortality and Fontan takedown/revision), postoperative length of stay, and complications, adjusting for other patient and center factors.
  
  
  RESULTS
  A total of 2,747 patients (68 centers) were included: 61% male; 45% right dominant lesions (38% left dominant, 17% undifferentiated). An extracardiac conduit Fontan (versus lateral tunnel) was performed in 63%; 65% were fenestrated. Median age, median weight at Fontan operation, and proportion with weight-for-age z-score less than -2 varied across centers and ranged from 1.7 to 4.8 years, 10.5 to 16.1 kg, and 0% to 30%, respectively. In multivariable analysis, age and weight were not significantly associated with outcome. Weight-for-age z-score less than -2 was associated with increased in-hospital mortality (odds ratio 2.73, 95% confidence interval: 1.09 to 6.86), Fontan failure (odds ratio 2.59, 95% confidence interval: 1.24 to 5.40), and longer length of stay (+1.2 days, 95% confidence interval: 0.1 to 2.4).
  
  
  CONCLUSIONS
  Weight-for-age z-score less than -2 is associated with significant morbidity and mortality after the Fontan operation independent of other patient and center characteristics.
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina 27715, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Wallace
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome