title: Congenital heart operations performed in the first year of life: does geographic variation exist?
abstract: BACKGROUND
  Geographic variations associated with surgical intervention for congenital heart disease are ill defined. This study uses a large clinical registry to assess frequency of surgical intervention for various infant congenital heart diseases overall and across US geographic regions.
  
  
  METHODS
  Patients younger than 1 year of age in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 2010 through June 2012) were included. Index operations were classified on the basis of seven major diagnostic groups and 10 specific diagnoses and were compared across geographic regions using a χ(2) test. Region was defined by patient residence.
  
  
  RESULTS
  The study included 23,379 patients (94 centers). Septal defects (26.2%) were the most frequently reported diagnostic group, and tetralogy of Fallot (10.6%) was the most frequent specific diagnosis. Significant geographic variation was noted for all seven major diagnostic groups. The proportion of patients undergoing surgery for septal defects varied from 23.9% to 30.2% (p = 0.001); pulmonary venous anomalies, 2.8% to 4.5% (p = 0.03); right heart lesions, 15.7% to 21.4% (p < 0.0001); left heart lesions, 22.7% to 30.4% (p = 0.0002); single-ventricle lesions, 7.3% to 11.4% (p < 0.0001); transposition of the great arteries and double-outlet right ventricle, 9.0% to 15.3% (p < 0.0001); and coronary artery anomalies, 0.4% to 1.4% (p = 0.04). Significant regional variation was also observed for 7 of the 10 specific diagnoses examined.
  
  
  CONCLUSIONS
  These data demonstrate significant variation in congenital heart disease diagnostic groups requiring surgery before 1 year of age across US geographic regions.
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Texas. Electronic address: husain@uhtscsa.edu.
authors.forename: S Adil
authors.initials: SA
authors.lastname: Husain
authors.affiliation: Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Department of Surgery, John Hopkins University, All Children's Hospital, St. Petersburg and Tampa, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Texas.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Kane
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Texas.
authors.forename: John H
authors.initials: JH
authors.lastname: Calhoon
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005843:Geography; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D014481:United States