Key result
Cardiac surgical centers are linked to ~74% higher ACHD non-cardiac procedure mortality, reflecting greater comorbidities.
Why the study?
Advances in CHD management have increased the adult CHD population requiring non-cardiac procedures, but characteristics and hospital admission patterns are not well described.
What are the admission patterns, patient characteristics, and mortality rates for adults with congenital heart disease undergoing non-cardiac procedures in hospitals with versus without cardiac surgical programmes?
Cohort (n=12,944)
Yes
What are the admission patterns, patient characteristics, and mortality rates for adults with congenital heart disease undergoing non-cardiac procedures in hospitals with versus without cardiac surgical programmes?
Absolute Event Rate: 4% vs 2.3%
p-value: p=<0.001
Adults with congenital heart disease undergoing non-cardiac procedures are predominantly managed in hospitals with cardiac surgical programmes, where they present with higher comorbidities and experience higher mortality.
Should not yet change referral patterns for ACHD non-cardiac procedures; leaves open whether case mix or center factors drive mortality.
OBJECTIVE: Advances in management of congenital heart disease (CHD) have led to an increasing population of adults with CHD, many of whom require non-cardiac procedures. The objectives of this study were to describe the characteristics of these patients, their distribution among different hospital categories and the characteristics determining this distribution, and mortality rates following noncardiac procedures. METHODS: We retrospectively analysed 27 state inpatient databases. Encounters with CHD and non-cardiac procedures were included. The location of care was classified into two categories: hospitals with and without cardiac surgical programmes. Variables included were demographics, comorbidity index, mortality. Multivariable logistic regression was used to explore predictors for care in different locations. RESULTS: The cohort consisted of 12 944 encounters in 1206 hospitals. Most patients were cared for in hospitals with a cardiac surgical programme (78.1%). Patients presenting to hospitals with a cardiac surgical programme presented with higher comorbidity index (6 (IQR: 0-19) vs 2 (IQR: -3-14), p<0.001) than patients presenting to hospitals without a cardiac surgical programme. Mortality was higher in hospitals with cardiac surgical programmes compared with hospitals without cardiac surgical programmes (4.0% vs 2.3%, p<0.001). Factors associated with provision of care at a hospital with a cardiac surgical programme were comorbidity index (>7: OR 2.01 (95% CI 1.83 to 2.21), p<0.001; 2-7: OR 1.59 (95% CI 1.41 to 1.79), p<0.001) and age (18-44 years: OR 1.43 (95% CI 1.26 to 1.62), p<0.001; 45-64 years: OR 1.21 (95% CI 1.08 to 1.34), p<0.001). CONCLUSION: Adults with CHD undergoing non-cardiac procedures are mainly cared for in hospitals with a cardiac surgical programme and have greater comorbidities and higher mortality than those in centres without cardiac surgical programmes. Risk stratification and locoregional accessibility need further assessment to fully understand admission patterns.
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Friess et al. (2023) conducted a cohort in Congenital heart disease requiring non-cardiac procedures (n=12,944). Admission to a hospital with a cardiac surgical programme vs. Admission to a hospital without a cardiac surgical programme was evaluated on In-hospital mortality (p=<0.001). Adults with congenital heart disease undergoing non-cardiac procedures at hospitals with a cardiac surgical program had higher in-hospital mortality (4.0% vs 2.3%) than those at centers without such programs, likely due to a greater burden of comorbidities.
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