title: The impact of cardiac risk factors on short-term outcomes for children undergoing a Ladd procedure.
abstract: OBJECTIVE
  The purpose of this study was to describe the outcomes of children with and without congenital heart disease who undergo a Ladd procedure.
  
  
  METHODS
  The 2012-2014 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data were queried for patients undergoing a Ladd procedure. Utilizing NSQIP-P definitions, patients were categorized into four cardiac risk groups (none, minor, major, severe) based on severity of cardiac anomalies, previous cardiac procedure(s), and ongoing cardiac dysfunction. Ladd procedures were elective/non-elective. Outcomes included length of stay, adverse events, and mortality.
  
  
  RESULTS
  878 patients underwent Ladd procedures. 633 (72%) patients had no cardiac risk factors and 84 (10%), 109 (12%), and 52 (6%) had minor, major, and severe cardiac risk factors, respectively. Children with congenital heart disease experienced increased morbidity and mortality and longer hospital stays (all p<0.05). Elective Ladd procedures were associated with similar morbidity but shorter length of stay and lower mortality than non-elective procedures. Older age at time of operation was associated with fewer adverse events.
  
  
  CONCLUSIONS
  Although overall mortality remains low, children with higher risk cardiac disease experience increased morbidity and mortality when undergoing a Ladd procedure. Older age at the time of the Ladd procedure was associated with improved outcomes in children.
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Anderson
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of General Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.252, Houston, TX 77030, USA.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Lugo
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA. Electronic address: akemi.kawaguchi@uth.tmc.edu.
authors.forename: Akemi L
authors.initials: AL
authors.lastname: Kawaguchi
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000150:complications / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cardiac risk; Ladd procedure; Malrotation; NSQIP