title: Outcomes differ in patients who undergo immediate intraoperative revision versus patients with delayed postoperative revision of residual lesions in congenital heart operations.
abstract: OBJECTIVE
  In a previous study of infants less than 6 month old, we found that delayed revision of residual lesions resulted in worse patient outcomes compared with intraoperative revision. We explored a larger cohort to determine if this finding persisted.
  
  
  METHODS
  A prospective cohort followed from index surgery to discharge from January 2011 to September 2013 were divided into 4 groups: (1) intraoperative revisions (IO) of residual lesions, (2) delayed postoperative revision (PO) of residual lesions during the same hospital stay, (3) both intraoperative and delayed (BOTH) revision of residual lesions, (4) no intraoperative or postoperative revision (NO). Linear and logistic regression analyses were used to compare outcomes of postoperative hospital length of stay, postoperative adverse events (AE), hospital costs, and mortality, after adjusting for age, prematurity, presence of extracardiac anomalies, and RACHS-1 (Risk Adjustment for Congenital Heart Surgery-1) risk category known to affect outcomes.
  
  
  RESULTS
  Of the 2427 patients discharged after a congenital cardiac operation, 1886 were eligible for this study after exclusion of adults, procedures performed off cardiopulmonary bypass, and transplants and assist devices. On multivariable modeling adjusting for other significant patient factors, the NO group fared better than the other 3 groups. The IO group had significantly lower postoperative length of stay, AE rate, and hospital costs compared with the PO and BOTH groups, but showed no significant differences in mortality.
  
  
  CONCLUSIONS
  Intraoperative correction of residual lesions results in shorter length of stay, and lower postoperative AE and costs compared with delayed postoperative revision of residual lesions.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: meena.nathan@cardio.chboston.org.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome