title: Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome.
abstract: Information is limited regarding the effect of race, ethnicity, and gender on the outcomes of the three palliative procedures for hypoplastic left heart syndrome (HLHS). This study examined the effects of race, ethnicity, gender, type of admission, and surgical volume on in-hospital mortality associated with palliative procedures for HLHS between 1998 and 2007 using data from the University HealthSystem Consortium. According to the data, 1,949 patients underwent stage 1 palliation (S1P) with a mortality rate of 29 %, 1,279 patients underwent stage 2 palliations (S2P) with a mortality rate of 5.4 %, and 1,084 patients underwent stage 3 palliation (S3P) with a mortality rate of 4.1 %. The risk factors for increased mortality with S1P were black and "other" race, smaller surgical volume, and early surgical era. The only risk factors for increased mortality with S2P were black race (11 % mortality; odds ratio [OR], 3.19; 95 % confidence interval [CI] 1.69-6.02) and Hispanic ethnicity (11 % mortality; OR 3.30; 95 % CI 1.64-6.64). For S2P, no racial differences were seen in the top five surgical volume institutions, but racial differences were seen in the non-top-five surgical volume institutions. Mortality with S1P was significantly higher for patients discharged after birth (37 vs 24 %; p = 0.004), and blacks were more likely to be discharged after birth (12 vs 5 % for all other races; p < 0.001). No racial differences with S3P were observed. The risk factors for increased mortality at S1P were black and "other" race, smaller surgical volume, and early surgical era. The risk factors for increased in-hospital mortality with S2P were black race and Hispanic ethnicity.
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Avenue, Washington, DC, 20010-2970, USA, pdean@childrensnational.org.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Dean
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: McHugh
authors.forename: Mark R
authors.initials: MR
authors.lastname: Conaway
authors.forename: Diane G
authors.initials: DG
authors.lastname: Hillman
authors.forename: Howard P
authors.initials: HP
authors.lastname: Gutgesell
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005006:Ethnicity; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000208:ethnology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality*; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology