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Original research
Major elective non-cardiac operations in adults with congenital heart disease
  1. Catherine G Williamson1,
  2. Shayan Ebrahimian1,
  3. Nameer Ascandar1,
  4. Yas Sanaiha1,2,
  5. Sara Sakowitz1,
  6. Reshma M Biniwale2,
  7. Peyman Benharash1,2
  1. 1Cardiovascular Outcomes Research Laboratories, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2Department of Cardiothoracic Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Dr Peyman Benharash, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA; pbenharash{at}mednet.ucla.edu

Abstract

Objective To assess the impact of congenital heart disease (CHD) on resource utilisation and clinical outcomes in patients undergoing major elective non-cardiac operations.

Background Due to advances in congenital cardiac management in recent years, more patients with CHD are living into adulthood and are requiring non-cardiac operations.

Methods The 2010–2018 Nationwide Readmissions Database was used to identify all adults undergoing major elective operations (pneumonectomy, hepatectomy, hip replacement, pancreatectomy, abdominal aortic aneurysm repair, colectomy, gastrectomy and oesophagectomy). Multivariable regression models were used to categorise key clinical outcomes.

Results Of an estimated 4 941 203 adults meeting inclusion criteria, 5234 (0.11%) had a previous diagnosis of CHD. Over the study period, the incidence of CHD increased from 0.06% to 0.17%, p<0.001. CHD patients were on average younger (63.3±14.8 vs 64.4±12.5 years, p=0.004), had a higher Elixhauser Comorbidity Index (3.3±2.2 vs 2.3±1.8, p<0.001) and received operations at high volume centres more frequently (66.6% vs 62.0%, p=0.003). Following risk adjustment, these patients had increased risk of in-hospital mortality (adjusted risk ratio (ARR): 1.76, 95% CI 1.25 to 2.47), experienced longer hospitalisation durations (+1.6 days, 95% CI 1.3 to 2.0) and cost more (+$8370, 95% CI $6686 to $10 055). Furthermore, they were more at risk for in-hospital complications (ARR: 1.24 95% CI 1.17 to 1.31) and endured higher adjusted risk of readmission at 30 days (ARR: 1.32 95% CI 1.13 to 1.54).

Conclusions Adults with CHD are more frequently comprising the major elective operative cohort for non-cardiac cases. Due to the inferior clinical and financial outcomes suffered by this population, perioperative risk stratification may benefit from the inclusion of CHD as a factor that portends unfavourable outcomes.

  • Congenital heart disease
  • Quality of Health Care
  • Congenital Abnormalities

Data availability statement

Data are available in a public repository.

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Data availability statement

Data are available in a public repository.

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Footnotes

  • Twitter @c_gwilliamson, @Nameer Ascandar, @yassanaiha, @corelabUCLA

  • Contributors CW and PB designed the study. CW, SE, YS, NA and SS analysed and interpreted data. CW, RB and PB wrote the manuscript and all authors revised it. PB serves as the overall guarantor responsible for overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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