title: Risk Factors for Interstage Mortality Following the Norwood Procedure: Impact of Sociodemographic Factors.
abstract: Interstage mortality remains significant for patients undergoing staged palliation for hypoplastic left heart syndrome and other related single right ventricle malformations (HLV). The purpose of this study was to identify factors related to demographics, socioeconomic position, and perioperative course associated with post-Norwood hospital discharge, pre-stage 2, interstage mortality (ISM). Medical record review was conducted for patients with HLV, born from 1/2000 to 7/2009 and discharged alive following the Norwood procedure. Sociodemographic and perioperative factors were reviewed. Patients were determined to have ISM if they died between Norwood procedure hospital discharge and stage 2 palliation. Univariable and multivariable logistic regressions were performed to identify risk factors associated with ISM. A total of 273 patients were included in the analysis; ISM occurred in 32 patients (12%). Multivariable analysis demonstrated that independent risk factors for interstage mortality included teen mothers [adjusted odds ratio (AOR) 6.6, 95% confidence interval (CI) 1.9-22.5], single adult caregivers (AOR 4.1, 95% CI 1.2-14.4), postoperative dysrhythmia (AOR 2.7, 95% CI 1.1-6.4), and longer ICU stay (AOR 2.7, 95% CI 1.2-6.1). Anatomic and surgical course variables were not associated with ISM in multivariable analysis. Patients with HLV are at increased risk of ISM if born to a teen mother, if they lived in a home with only one adult caregiver, suffered a postoperative dysrhythmia, or experienced a prolonged ICU stay. These risk factors are identifiable, and thus these infants may be targeted for interventions to reduce ISM.
authors.affiliation: Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA. taylorlc@med.umich.edu.|Department of Internal Medicine and Pediatrics, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-4204, USA. taylorlc@med.umich.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Taylor
authors.affiliation: Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
authors.forename: Brendan
authors.initials: B
authors.lastname: Burke
authors.affiliation: Department of Pediatrics, M-CHORD (Michigan Congenital Heart Outcomes Research and Discovery), C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: Department of Pediatrics, M-CHORD (Michigan Congenital Heart Outcomes Research and Discovery), C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Pediatric Cardiac Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
authors.affiliation: Department of Pediatric Cardiac Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Caren S
authors.initials: CS
authors.lastname: Goldberg
mesh_terms: D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: Hypoplastic left ventricle; Interstage mortality; Norwood; Sociodemographic