title: Impact of preoperative location on outcomes in congenital heart surgery.
abstract: BACKGROUND
  Little is known about the impact of preoperative location on outcomes in infants undergoing cardiac surgery for congenital heart disease. This study was designed to evaluate the morbidity and mortality among infants who were cared for in a neonatal ICU (NICU) versus dedicated cardiovascular intensive care unit (CVICU) prior to cardiac surgery in a multi-institutional population.
  
  
  METHODS
  Data were obtained from a multicenter, administrative, national dataset, Pediatric Health Information System (PHIS). Patients 0 to 45 days undergoing surgery for congenital heart disease (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004 to 2013) were included. Propensity score matching was performed to match the NICU and the CVICU patients with similar demographic and preoperative clinical characteristics.
  
  
  RESULTS
  A total of 5,376 patients from 20 hospitals met inclusion criteria. By propensity score matching, 2,456 patients matched 1 to 1 between the NICU and the CVICU groups. Outcomes including mortality (NICU vs CVICU, 11.9% vs 8.8%, p < 0.001), preoperative and total hospital length of stay (LOS), and total length of mechanical ventilation were significantly greater among the NICU patients compared with the CVICU patients. There was no significant difference in mortality among the patients undergoing "low" complexity operations (NICU vs CVICU, 8.4% vs 6.7%, p = 0.22), and patients undergoing treatment at high volume hospitals (NICU vs CVICU, 9.6% vs 9.5%, p = 0.95).
  
  
  CONCLUSIONS
  This study demonstrates that preoperative location might impact outcomes in children undergoing operation for congenital heart disease. It is possible that preoperative location may be surrogate for other factors that may bias the results. Further study is warranted.
authors.affiliation: Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: pgupta2@uams.edu.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Beam
authors.affiliation: Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Tommy R
authors.initials: TR
authors.lastname: Noel
authors.affiliation: Biostatistics Shared Resource, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Igor
authors.initials: I
authors.lastname: Dvorchik
authors.affiliation: Biostatistics Shared Resource, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Han
authors.initials: H
authors.lastname: Yin
authors.affiliation: Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D008297:Male; D057234:Preoperative Period; D016896:Treatment Outcome