title: Early primary repair of tetralogy of Fallot does not lead to increased postoperative resource utilization.
abstract: BACKGROUND
  Although early primary repair of tetralogy of Fallot has gained wider acceptance, there is some speculation that repair at a younger age may be associated with increased morbidity and resource utilization.
  
  
  METHODS
  A retrospective review of all consecutive patients undergoing tetralogy of Fallot repair between September 2004 and December 2011 was performed. Primary end points were hospital charges, and surrogates of postoperative hospital resource utilization, including ventilation time, intensive care unit (ICU) stay, and hospital stay. The secondary end point was operative death. Logistic regression analysis was used to determine factors associated with increased postoperative hospital resource utilization.
  
  
  RESULTS
  Among 164 patients in the study, there was 1 hospital death (0.6%). After excluding 9 patients who had palliative procedures before their repair, 155 comprised the primary repair group. Multivariate linear regression analysis revealed prematurity (p = 0.018), a nonelective operation (p < 0.001), and major extracardiac anomalies (p = 0.003) were independent predictors of increased postoperative hospital charges. Prematurity (p < 0.002), low birth weight (p = 0.047), and major extracardiac anomalies (p < 0.001) were significant predictors of increased ventilation time. Prematurity (p < 0.001), a nonelective operation (p < 0.001), and low birth weight (p = 0.048) significantly increased ICU length of stay. A nonelective operation (p = 0.025) and major extracardiac anomalies (p < 0.001) were predictors of an increased hospital stay. Younger age at repair was not associated with any increase in ventilation time, ICU stay, hospital stay, or with an increase in hospital charges.
  
  
  CONCLUSIONS
  Extracardiac anomalies, prematurity, low birth weight, and nonelective surgical intervention are predictors of increased morbidity and increased hospital resource utilization and impose a significant cost burden to the care of these patients. Early primary repair of tetralogy of Fallot can be safely performed without any increase in morbidity or increased hospital resource utilization.
authors.affiliation: Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC.
authors.forename: Syed Murfad
authors.initials: SM
authors.lastname: Peer
authors.affiliation: Department of Surgery and Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC. Electronic address: psinha@childrensnational.org.
authors.forename: Pranava
authors.initials: P
authors.lastname: Sinha
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors; D014481:United States