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Original research article
National trends in Fontan operation and in-hospital outcomes in the USA
  1. Emmanuel Akintoye1,
  2. William R Miranda2,
  3. Gruschen R Veldtman3,
  4. Heidi M Connolly2,
  5. Alexander C Egbe2
  1. 1 Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
  2. 2 Depertment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
  1. Correspondence to Dr Alexander C Egbe, Depertment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; cegbe2001{at}


Background National prevalence and outcomes of Fontan operation in the USA is unknown. Study objective was to determine trends (temporal change) in the annual volume of Fontan operations, in-hospital mortality, postoperative complications and type of hospital discharge.

Methods Review of the Nationwide Inpatient Sample for patients that underwent Fontan operation from 2001 to 2014 using the International Classification of Diseases-Ninth Revision, Clinical Modification procedure code for Fontan operation, that is, 35.94. To evaluate for change in patients’ demographics over the years, we divided the patient population into four groups based on procedure year (2001–2004, 2005–2008, 2009–2011 and 2012–2014).

Results An estimated 15 934 Fontan operations were performed in the USA from 2001 to 2014. Median (Q1–Q3) age was 3 (2–4) years and 39.8% were female. Hypoplastic left heart syndrome was the most common (29%) congenital heart disease diagnosis. An estimated 1175 procedures were performed in 2001 and 1340 in 2014, but there was no significant change in the number of procedures per year (p=0.47). There was significant decline in in-hospital mortality from 4.5% (53/1175) in 2001 to 1.1% (15/1340) in 2014 (p=0.009). When we compared event rates between 2001–2004 and 2012–2014 periods, there was significant decline in postoperative cardiac complications (12.6% (459/3640) to 8% (378/4706), p=0.007) and respiratory complications (17.1% (623/3640) to 10.2% (481/4706), p<0.001). However, there was increase in the number of patients discharged to home with healthcare assistance or transferred to another acute care facility (5.8% (211/3640) to 9.4% (443/4706), p=0.01) and inflation-adjusted hospitalisation cost (US$46 978 to US$60 383, p<0.001), but no significant change in length of stay (p=0.73).

Conclusion On the average, 1062 Fontan operations are performed annually in the USA with no change in volume of procedures but a decrease in in-hospital mortality and postoperative complications over a 15-year period.

  • fontan operation
  • in-hospital mortality
  • national trends

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  • Contributors ACE and EA: analysis and interpretation. ACE and EA: manuscript drafting and revision. All authors; final approval: all authors.

  • Funding ACE is supported by the National Heart, Lung, and Blood Institute (NHLBI) grant K23 HL141448-01.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Mayo Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.