Risk Factors for One-Year Postdischarge Mortality: An Analysis From the World Database for Pediatric and Congenital Heart Surgery

Abstract

Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS) was utilized to define the incidence of one-year mortality and identify associated risk factors following surgery for congenital heart disease. Methods: The WDPCHS was queried from January 2017 to September 2022 for all tier 1 surgeries submitted to the database. Out-of-hospital death was defined as a death between 30 days postoperatively and up to one year. Preoperative risk factors and other demographics were evaluated. Chi-square test was used to evaluate associations, a multivariable logistic regression model was performed and the P value for statistical significance was set at <.05. Results: Among 9764 patients alive at hospital discharge (or 30 days), overall, one-year mortality was 1.47% (n = 144). Mortality was highest in STAT 5, 22.88% (27/118) (P < .0001). Risk factors with a higher incidence of one-year mortality included: non-Trisomy 21 genetic syndromes 6.38% (18/282), more than three preoperative risk factors 12.12% (16/132), more than three postoperative complications 9.81% (37/377) all P < .0001. Highest mortality by procedure was seen with the Norwood procedure 22.88% (27/118) and truncus arteriosus repair 8.97% (7/78), both P < .0001. By multivariable analysis, the risk of one-year mortality remained significantly higher with more than three preoperative risk factors (OR 5.85, 95% CI 3.12-10.96), non-Trisomy 21 chromosomal abnormalities (OR 3.04, 95% CI 1.75-5.29), and STAT 5 cases (OR 28.4, 95% CI 15.02-53.71). Conclusions: Based on these findings, there are certain risk factors (multiple preoperative risk factors, chromosomal abnormalities, STAT 5 category) that warrant targeted increased surveillance to improve one-year outcomes.

Keywords: congenital heart disease; congenital heart surgery; database; international collaboration.