title: Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries.
abstract: OBJECTIVE
  This study sought to examine the impact of surgical timing on major morbidity and hospital reimbursement for late preterm and term infants with dextrotransposition of the great arteries (d-TGA).
  
  
  BACKGROUND
  Neonatal arterial switch operation is the standard of care for d-TGA. Little is known about the effects of age at operation on clinical outcomes or costs for these neonates.
  
  
  METHODS
  We conducted a retrospective cohort study of infants at ≥36 weeks' gestation, with d-TGA, with or without ventricular septal defects, admitted to our institution at 5 days of age or younger, between January 1, 2003 and October 1, 2012. Children with other cardiac abnormalities or other major comorbid conditions were excluded. Univariable and multivariable analyses were performed to determine the effects of age at operation on major morbidity and hospital reimbursement.
  
  
  RESULTS
  A total of 140 infants met inclusion criteria. Reimbursement data were available for them through January 1, 2012 (n = 128). The mortality rate was 1.4% (n = 2). Twenty percent (n = 28) experienced a major morbidity. The median costs were $60,000, in 2012 dollars (range: $25,000 to $549,000). The median age at operation was 5 days (range: 1 to 12 days). For every day later that surgery was performed, beyond day of life 3, the odds of major morbidity increased by 47% (range: 23% to 66%, p < 0.001) and costs increased by 8% (range: 5% to 11%, p < 0.001), after considering the effects of sex, birth weight, gestational age, year at which surgery was performed, transfer, weekend admission, insurance, surgeon, septostomy, bypass and cross-clamp times, and the presence of ventricular septal defects or abnormal coronary anatomy.
  
  
  CONCLUSIONS
  Delay of neonatal arterial switch operation beyond 3 days is significantly associated with increased morbidity and healthcare costs.
authors.affiliation: Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital Columbia University Medical Center, New York, New York.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Anderson
authors.affiliation: Department of Biostatistics, Columbia University, New York, New York.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Ciarleglio
authors.affiliation: Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital Columbia University Medical Center, New York, New York.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Hayes
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.affiliation: Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital Columbia University Medical Center, New York, New York.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: eb2709@columbia.edu.
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods*; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ASO; BAS; BP; MRI; VSD; XC; arterial switch operation; balloon atrial septostomy; bypass; costs; cross-clamp; d-TGA; dextrotransposition of the great arteries; magnetic resonance imaging; outcomes; surgical timing; transposition of the great arteries; ventricular septal defect