title: Regionalization in neonatal congenital heart surgery: the impact of distance on outcome after discharge.
abstract: Studies have shown improved perioperative outcomes after neonatal heart surgery at centers with greater surgical volumes. The impact of increasing distance from such centers on outcome after discharge has not yet been reported. Chart review and cross-sectional survey were performed on children discharged or transferred after undergoing neonatal congenital heart surgery as neonates (<30 days of age) from January 2005 to June 2006. The association of distance from center with mortality and adverse events was analyzed by univariate and multivariate regression and stratified by the Risk Adjustment for Congenital Heart Surgery-1 for complexity. Among 217 patients, those living further from the surgical center were smaller and older at surgery and more likely to be RACHS-1 class 6. Overall mortality was 8% (16 of 202) and was not associated with distance. Surveys were completed by 109 (54%) families with mean follow-up of 24 (± 3) months. Unplanned admissions after discharge and unplanned interventions occurred in 45% and 40% of patients, respectively. After adjusting for case complexity, living 90-300 min away from the surgical center was associated with fewer unplanned admissions compared with those living <90 min away. After neonatal cardiac surgery, adverse events were common. Distance from the surgical center was not associated with mortality, but it was associated with morbidity in a nonlinear fashion. This relation, its mediators, and its possible impact on mortality and later outcomes warrant further study to aid in planning appropriate patient follow-up.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. nelangi.pinto@imail.org
authors.forename: Nelangi M
authors.initials: NM
authors.lastname: Pinto
authors.forename: Javier
authors.initials: J
authors.lastname: Lasa
authors.forename: Troy E
authors.initials: TE
authors.lastname: Dominguez
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge; D011182:Postoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome