title: Longer hospital stay after Fontan completion in the November to March period.
abstract: OBJECTIVE
  Initial evidence suggests that total cavopulmonary connection (TCPC) completion during winter is associated with prolonged pleural effusion and hospitalization. This study was carried out to review the impact of season of operation on short-term outcome after TCPC procedure.
  
  
  METHODS
  We conducted a retrospective study on 104 consecutive patients who underwent the extracardiac TCPC procedure from June 2006 to November 2011 (mean age 5.0 ± 2.6 years, 60 males). The outcomes of interest assessed were length of postoperative hospital stay (LOS) and duration of pleural drainage. These were adjusted to potential, known standard Fontan risk factors such as age, ventricular morphology, cardiac function and previous surgical history. Length of chest drainage and LOS in the period November-March (NM) was compared with that in the period April-October (AO).
  
  
  RESULTS
  Of the 104 patients, 6 patients were excluded since they either required early reoperation or were transferred to another institution for their postoperative care. The group included 26 children with hypoplastic left heart syndrome. Thirty-four of the 98 remaining patients (34.7%) had surgery in the NM period. Overall, length of pleural drainage was 9 days (interquartile range 6-13) and LOS was 12 days (9-17). TCPC surgery in the NM period (P = 0.045), male gender (P = 0.020) and right ventricular morphology (P = 0.034) were the only variables associated with prolonged LOS at univariate analysis; no other factor including ventricular function, Glenn pressure, weight and age at operation were associated with LOS. NM surgery was the only predictor of LOS at multivariate analysis (P = 0.045). Patients with surgery in the NM period had a higher incidence of low cardiac output/acute renal dysfunction postoperatively (26.5 vs 9.4%, P = 0.038) and a higher incidence of infections requiring antibiotic use (64.7 vs 32.8%, P = 0.003).
  
  
  CONCLUSIONS
  TCPC surgery performed in the period between November and March is associated with increased morbidity, especially longer hospitalization. Given the elective nature of TCPC operation, this operation should be scheduled outside of the NM period if possible.
authors.affiliation: Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Souheir
authors.initials: S
authors.lastname: Salam
authors.affiliation: Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Troy
authors.initials: T
authors.lastname: Dominguez
authors.affiliation: Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.affiliation: Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK alessandro.giardini@gosh.nhs.uk.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giardini
mesh_terms: D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data*; D008131:London; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons
keywords: Cardiac–other; Congenital–Cyanotic; Congestive heart failure