Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery

• Published in: World journal for pediatric & congenital heart surgery 2024-05, Vol.15 (3), p.303-312
• Main Authors: Prabhu, Neel K., Moya-Mendez, Mary E., Kang, Lillian, Medina, Cathlyn K., McCrary, Andrew W., Allareddy, Veerajalandhar, Overbey, Douglas, Turek, Joseph W.
• Format: Article
• Language: English
• Subjects: Child, Preschool; Female; Fontan Procedure - methods; Fontan Procedure - mortality; Heart Bypass, Right - mortality; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Infant; Male; Retrospective Studies; Treatment Outcome; Univentricular Heart - mortality; Univentricular Heart - surgery
• ISSN: 2150-1351; 2150-136X
• DOI: 10.1177/21501351231215261

Background: To develop a more holistic measure of congenital heart center performance beyond mortality, we created a composite “textbook outcome” (TO) for the Glenn operation. We hypothesized that meeting TO would have a positive prognostic and financial impact. Methods: This was a single center retrospective study of patients undergoing superior cavopulmonary connection (bidirectional Glenn or Kawashima ± concomitant procedures) from 2005 to 2021. Textbook outcome was defined as freedom from operative mortality, reintervention, 30-day readmission, extracorporeal membrane oxygenation, major thrombotic complication, length of stay (LOS) >75th percentile (17d), and mechanical ventilation duration >75th percentile (2d). Multivariable logistic regression and Cox proportional hazards modeling were used. Results: Fifty-one percent (137/269) of patients met TO. Common reasons for TO failure were prolonged LOS (78/132, 59%) and ventilator duration (67/132, 51%). In multivariable analysis, higher weight [odds ratio, OR: 1.44 (95% confidence interval, CI: 1.15-1.84), P = .002] was a positive predictor of TO achievement while right ventricular dominance [OR 0.47 (0.27-0.81), P = .007] and higher preoperative pulmonary vascular resistance [OR 0.58 (0.40-0.82), P = .003] were negative predictors. After controlling for preoperative factors and excluding operative mortalities, TO achievement was independently associated with a decreased risk of death over long-term follow-up [hazard ratio: 0.50 (0.25-0.99), P = .049]. Textbook outcome achievement was also associated with lower direct cost of care [$137,626 (59,333-167,523) vs $262,299 (114,200-358,844), P