title: Unplanned reinterventions are associated with postoperative mortality in neonates with critical congenital heart disease.
abstract: OBJECTIVE
  Neonates with critical congenital heart disease remain at risk of adverse outcomes after cardiac surgery. Residual or undiagnosed anatomic lesions might be contributory. The present study aimed to describe the incidence and type of cardiac lesions that lead to early, unplanned cardiac reintervention, identify the risk factors for unplanned reintervention, and explore the associations between unplanned reinterventions and hospital mortality.
  
  
  METHODS
  The present single-center retrospective cohort study included 943 consecutive neonates with critical congenital heart disease who underwent cardiac surgery from 2002 to 2008. An unplanned cardiac reintervention was defined as a cardiac reoperation or interventional cardiac catheterization performed during the same hospitalization as the initial operation. Multivariate logistic regression analyses were used to identify the risk factors for unplanned cardiac reintervention and hospital mortality.
  
  
  RESULTS
  Of the 943 neonates, 104 (11%) underwent an unplanned cardiac reintervention. The independent predictors of unplanned reintervention included prenatal diagnosis, lower birth weight, need for mechanical ventilation before the initial cardiac operation, lower attending surgeon experience, and greater Risk Adjustment in Congenital Heart Surgery, version 1, category. Those who underwent reintervention had increased hospital mortality (n = 33/104, 32%) relative to those who did not (n = 31/839, 4%; adjusted odds ratio, 8.6; 95% confidence interval, 4.7 to 15.6; P < .001). The mortality rates among patients undergoing surgical reintervention (23/66, 35%) or transcatheter reintervention (4/16, 25%), or both (6/22, 27%) were similar (P = .66).
  
  
  CONCLUSIONS
  The need for unplanned cardiac reintervention in neonates with critical congenital heart disease is strongly associated with increased mortality. Early unplanned reinterventions might be an important covariate in outcomes studies and useful as a quality improvement measure.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA.
authors.forename: Mjaye L
authors.initials: ML
authors.lastname: Mazwi
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors