Factors Associated with Mortality and Adverse Outcomes in Infants Undergoing Truncus Arteriosus Repair

Background: Truncus arteriosus repair has been associated with higher morbidity and mortality compared to other congenital heart operations. Utilizing a large multicenter administrative dataset, we sought to determine factors associated with mortality and adverse outcomes in infants undergoing truncus arteriosus repair.

Methods: We utilized the Pediatric Health Information System (PHIS) Database to identify infants < 90 days old who underwent truncus arteriosus repair from 2004-2019. The primary outcome was hospital mortality. Secondary outcomes were prolonged postoperative length of stay (LOS; >30 days) and hospital readmission within 90 days. Multivariable logistic regression models were used to identify associated factors for adverse outcomes.

Results: A total of 1,645 subjects were included. Hospital mortality occurred in 164 (10%). Median postoperative LOS was 20 days (25th %ile, 11 days; 75th %ile, 37days); prolonged postoperative LOS > 30 days occurred in 508 (31%). In 1,481 patients who survived to hospital discharge, readmission at 90 days occurred in 511 (34%). Factors independently associated with mortality included birth weight <3 kg, admit age <48 hours, truncal valve surgery, cardiac arrest, ECMO, acute kidney injury (AKI), cardiac catheterization, tracheostomy, and earlier era (Table 1). Factors independently associated with postoperative LOS >30 days included prematurity, DiGeorge syndrome, genetic syndromes other than DiGeorge, admit age <48 hours, AKI, infection, cardiac catheterization, vocal cord paralysis, surgical complication, tracheostomy, and gastrostomy (Table 2). DiGeorge syndrome, cleft lip/palate, cardiac catheterization, and ECMO were factors independently associated with hospital readmission (Table 2).

Conclusion: In this large, multicenter study we identified multiple factors associated with hospital mortality and prolonged postoperative length of stay in infants undergoing truncus arteriosus repair, some of which are potentially modifiable. This information could be useful for quality improvement initiatives, perioperative counseling, and discharge planning in infants undergoing truncus arteriosus repair.