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Ann Thorac Surg 2011;91:1445-1452. doi:10.1016/j.athoracsur.2010.11.064
© 2011 The Society of Thoracic Surgeons
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James Jaggers
Marshall L. Jacobs
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Original Articles: Pediatric Cardiac

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

Michelle C. Wallace, MDa, James Jaggers, MDe, Jennifer S. Li, MD, MHSa,d, Marshall L. Jacobs, MDf, Jeffrey P. Jacobs, MDg, Daniel K. Benjamin, PhDd, Sean M. O'Brien, PhDc,d, Eric D. Peterson, MD, MPHb,d, P. Brian Smith, MD, MPHa,d, Sara K. Pasquali, MDa,d,*

a Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
b Department of Medicine, Duke University School of Medicine, Durham, North Carolina
c Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina
d Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
e Department of Surgery, University of Colorado School of Medicine, Denver, Colorado
f Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio
g Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, St. Petersburg and Tampa, Florida

Accepted for publication November 24, 2010.

* Address correspondence to Dr Pasquali, Duke University Medical Center, Duke Clinical Research Institute, Box 17969, Durham, NC 27715 (Email: sara.pasquali{at}duke.edu).

Background: The impact of age and weight on outcomes after 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 postoperative morbidity and mortality.

Methods: Patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000 to 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), postoperative length of stay, and complications, adjusting for other patient and center factors.

Results: A total of 2,747 patients (68 centers) were included: 61% male; 45% right dominant lesions (38% left dominant, 17% undifferentiated). An extracardiac conduit Fontan (versus lateral tunnel) was performed in 63%; 65% were fenestrated. Median age, median weight at Fontan operation, and proportion with weight-for-age z-score less than –2 varied across centers and ranged from 1.7 to 4.8 years, 10.5 to 16.1 kg, and 0% to 30%, respectively. In multivariable analysis, age and weight were not significantly associated with outcome. Weight-for-age z-score less than –2 was associated with increased in-hospital mortality (odds ratio 2.73, 95% confidence interval: 1.09 to 6.86), Fontan failure (odds ratio 2.59, 95% confidence interval: 1.24 to 5.40), and longer length of stay (+1.2 days, 95% confidence interval: 0.1 to 2.4).

Conclusions: Weight-for-age z-score less than –2 is associated with significant morbidity and mortality after the Fontan operation independent of other patient and center characteristics.




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