title: Unexpected deaths and unplanned re-admissions in infants discharged home after cardiac surgery: a systematic review of potential risk factors.
abstract: BACKGROUND
  Babies with CHDs are a particularly vulnerable population with significant mortality in their 1st year. Although most deaths occur in the hospital within the early postoperative period, around one-fifth of postoperative deaths in the 1st year of life may occur after hospital discharge in infants who have undergone apparently successful cardiac surgery. Aim To systematically review the published literature and identify risk factors for adverse outcomes, specifically deaths and unplanned re-admissions, following hospital discharge after infant surgery for life-threatening CHDs.
  
  
  METHODS
  A systematic search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO electronic databases, supplemented by manual searching of conference abstracts.
  
  
  RESULTS
  A total of 15 studies were eligible for inclusion. Almost exclusively, studies were conducted in single US centres and focussed on children with complex single ventricle diagnoses. A wide range of risk factors were evaluated, and those more frequently identified as having a significant association with higher mortality or unplanned re-admission risk were non-Caucasian ethnicity, lower socio-economic status, co-morbid conditions, age at surgery, operative complexity and procedure type, and post-operative feeding difficulties.
  
  
  CONCLUSIONS
  Studies investigating risk factors for adverse outcomes post-discharge following diverse congenital heart operations in infants are lacking. Further research is needed to systematically identify higher risk groups, and to develop interventions targeted at supporting the most vulnerable infants within an integrated primary and secondary care pathway.
authors.affiliation: 1Cardiorespiratory Unit,Great Ormond Street Hospital NHS Foundation Trust,London,United Kingdom.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Tregay
authors.affiliation: 1Cardiorespiratory Unit,Great Ormond Street Hospital NHS Foundation Trust,London,United Kingdom.
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.affiliation: 1Cardiorespiratory Unit,Great Ormond Street Hospital NHS Foundation Trust,London,United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bull
authors.affiliation: 2Department of Paediatric Cardiology,Royal Brompton & Harefield NHS Trust,London,United Kingdom.
authors.forename: Rodney C
authors.initials: RC
authors.lastname: Franklin
authors.affiliation: 2Department of Paediatric Cardiology,Royal Brompton & Harefield NHS Trust,London,United Kingdom.
authors.forename: Piers
authors.initials: P
authors.lastname: Daubeney
authors.affiliation: 3Cardiac Unit,Birmingham Children's Hospital NHS Foundation Trust,Birmingham,United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Barron
authors.affiliation: 1Cardiorespiratory Unit,Great Ormond Street Hospital NHS Foundation Trust,London,United Kingdom.
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown
authors.affiliation: 4Population Policy and Practice Programme,UCL Institute of Child Health,London,United Kingdom.
authors.forename: Rachel L
authors.identifier: http://orcid.org/0000-0002-5490-7682
authors.initials: RL
authors.lastname: Knowles
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010351:Patient Discharge; D012307:Risk Factors
keywords: Congenital heart disease; mortality; surgical outcomes; systematic review