Gestational Age at Birth and Outcomes After Neonatal Cardiac Surgery: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

• Published in: Circulation (New York, N.Y.) N.Y.), 2014-06, Vol.129 (24), p.2511-2517
• Main Authors: Costello, John M, Pasquali, Sara K, Jacobs, Jeffrey P, He, Xia, Hill, Kevin D, Cooper, David S, Backer, Carl L, Jacobs, Marshall L
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood and lymphatic vessels; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Databases, Factual - statistics & numerical data; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Gestational Age; Heart; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Hospital Mortality; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - mortality; Infant, Premature, Diseases - surgery; Length of Stay - statistics & numerical data; Male; Medical sciences; Postoperative Complications - mortality; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.005864

BACKGROUND—Gestational age at birth is a potentially important modifiable risk factor in neonates with congenital heart disease. We evaluated the relationship between gestational age and outcomes in a multicenter cohort of neonates undergoing cardiac surgery, focusing on those born at early term (ie, 37–38 weeks’ gestation). METHODS AND RESULTS—Neonates in the Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent cardiac surgery between 2010 and 2011 were included. Multivariable logistic regression was used to evaluate the association of gestational age at birth with in-hospital mortality, postoperative length of stay, and complications, adjusting for other important patient characteristics. Of 4784 included neonates (92 hospitals), 48% were born before 39 weeks’ gestation, including 31% at 37 to 38 weeks. Compared with a 39.5-week gestational age reference level, birth at 37 weeks’ gestational age was associated with higher in-hospital mortality, with an adjusted odds ratio (95% confidence interval) of 1.34 (1.05–1.71; P=0.02). Complication rates were higher and postoperative length of stay was significantly prolonged for those born at 37 and 38 weeks’ gestation (adjusted P