Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

Abstract

Background The impact of age and weight on outcomes following the Fontan operation is unclear. Previous analyses have suggested that lower weight-for-age z-score is an important predictor of poor outcome in patients undergoing bidirectional Glenn. We evaluated variation in age, weight, and weight-for-age z-score at Fontan across institutions, and the impact of these variables on post-operative morbidity and mortality. Methods Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000–2009) were included. Center variation in age, weight, and weight-for-age z-score were described. Multivariable analysis was performed to evaluate the impact of age, weight, and weight-for-age z-score on in-hospital mortality, Fontan failure (combined in-hospital mortality and Fontan takedown/revision), post-operative length of stay, and complications, adjusting for other patient and center factors. Results A total of 2747 patients (68 centers) were included: 61% male; 45% right dominant lesions (38% left dominant, 17% undifferentiated). An extracardiac conduit Fontan (vs. lateral tunnel) was performed in 63%; 65% were fenestrated. Median age and weight at Fontan operation and proportion with weight-for-age z-score <−2 varied across centers ranging from 1.7–4.8 yrs, 10.5–16.1 kg, and 0%–30%, respectively. In multivariable analysis, age and weight were not significantly associated with outcome. Weight-for-age z-score <−2 was associated with increased in-hospital mortality (OR 2.73, 95%CI 1.09–6.86), Fontan failure (OR 2.59, 95%CI 1.24–5.40), and longer length of stay (+1.2 days, 95%CI 0.1–2.4). Conclusions Weight-for-age z-score <−2 is associated with significant morbidity and mortality following the Fontan operation independent of other patient and center characteristics.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

“…Underweight status has been shown to predict outcomes in a variety of critically ill pediatric populations [20–22]. In a recent study of PICU admissions at a tertiary referral center in the U.K., mean weight for age was significantly lower than that of the national reference population [10].…”

Technical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure

“…Additionally, patient weight in our cohort (13.2 kg) was far lower than the average of our historical Fontan patients (15 kg), and recent data has correlated low weight-for-age with increased morbidity and longer hospital stays. 14,15 Perhaps most concerning is the occlusion of the left limb in patient 5. By dividing the IVC flow between 2 limbs, reduced flow occurs in both.…”

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

“…40 Further, in a population of children after Fontan surgery demonstrated that Z-score of less than -2 was significantly associated with mortality, surgical failure, and length of hospital stay. 41 Nutritional status calculated by weight for age formula and young age were correlated with length of stay and hemodynamic status after a Glenn bidirectional surgery. 42 While accompanied with hypoalbuminemia, a poor nutrition in children with congenital heart disease increased the risk of mortality and postsurgical infections as well as prolonged hospital stay.…”

“…Delay in early corrective cardiac surgery has been resulted in a high mortality and morbidity rate. 6 A three years study (1991)(1992)(1993)(1994) at the Southampton University Hospital, United Kingdom, demonstrated a 4.4% post cardiac surgery mortality rate (<30 days). This rate was even higher (18%) when the procedure was performed in emergency setting, 7 and 29% when performed in a younger age population (i.e.…”