title: Outcome of noncardiac surgery in children with congenital heart disease performed outside a cardiac center.
abstract: OBJECTIVE
  The objective of this study was to review the outcome of children with congenital heart disease (CHD) undergoing noncardiac surgery requiring general anesthesia (GA) in a tertiary pediatric center between January 2010 and December 2012.
  
  
  METHODS
  A retrospective case note review of children <16years of age with confirmed CHD undergoing a surgical or interventional procedure requiring GA was performed. Patients were categorized into three risk groups according to White and Peyton's anesthetic risk classification of children with CHD undergoing noncardiac surgery [Critical Care and Pain 2012;12:17-22].
  
  
  RESULTS
  117 children with CHD were identified with a total of 240 procedures conducted. 36 procedures were conducted in the high-risk group, 135 in the intermediate-risk group, and 69 in the low-risk group. 40% of these were major operations such as small bowel and colonic procedures. Overall mortality rate at 7days and 30days was 0% and 0.4%, respectively, with a 1% mortality rate in minor procedures and 0% mortality rate in major procedures. There were no unexpected deaths. 17% of procedures resulted in complications. A higher rate of complications was recorded in emergency procedures. 17% of these procedures required admission to the intensive care unit, with the highest admissions rate in the high-risk group. The median duration of hospital stay for the whole cohort was 1day (range of 0-71days).
  
  
  CONCLUSIONS
  Our study shows that procedures requiring GA can be safely conducted on children from any of the three risk groups in a nonspecialist cardiac center provided that there is close liaison and careful planning between the different specialties.
authors.affiliation: School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Shermayne M
authors.initials: SM
authors.lastname: Ng
authors.affiliation: School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Xi
authors.initials: X
authors.lastname: Jin
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Yates
authors.affiliation: Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK. Electronic address: wilf.kelsall@addenbrookes.nhs.uk.
authors.forename: Anthony W R
authors.initials: AW
authors.lastname: Kelsall
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality; D062606:Tertiary Care Centers
keywords: congenital heart disease; noncardiac surgery; outcome; pediatric