Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients.

BACKGROUND

Little is known regarding the risk factors for early and late death after hospital discharge among pediatric patients undergoing cardiac surgery.

METHODS

Statewide hospital discharge data from California in 1989 to 1999 were used to study outcomes of children <18 years old who had a procedure code (by International Classification of Diseases, Ninth Revision, Clinical Modification) indicating cardiac surgery. The outcome variable was death occurring after hospital discharge. Postdischarge deaths were identified by linking hospital discharge data to statewide death registry data. Cardiac surgical procedures were grouped into 23 categories to adjust for risk involved with the procedures. We used logistic regression to evaluate risk factors for postdischarge mortality, including variables age, sex, race and ethnicity, type of insurance, home income, date and month of surgery, type of admission, hospitals case volume, and the various types of procedures.

RESULTS

There were 25,402 cardiac surgery cases with 1505 inhospital deaths. Of 23,897 hospital discharges, 148 deaths (0.62%) occurred within 365 days after discharge, including 37 deaths within 30 days; 44 deaths at 31 to 90 days; and 67 deaths at 91 to 365 days. Logistic regression showed young age was an important risk factor for postdischarge death with an odds ratio of 4.8 for neonates and 3.5 for infants, compared with children >1 year old. Another significant risk factor was the type of procedure. For death <30 days after discharge, Norwood operation (odds ratio 8.4 compared with closure of ventricular septal defect) was a risk factor. For death that occurred between 31 and 365 days, significant risk factors were truncus arteriosus repair, total anomalous pulmonary vein repair, aortopulmonary shunt, and open valvotomy. Sex, race/ethnicity, home income, and hospital case volume were not significant predictors of postdischarge deaths.

CONCLUSIONS

Many demographic and socioeconomic variables affecting inhospital death were not significant predictors for postdischarge death. Important risk factors for postdischarge death were young age and the type of surgery performed.