S Adil Husain1, Sara K Pasquali2, Jeffrey P Jacobs3, Kevin D Hill4, Sunghee Kim4, Lauren C Kane5, John H Calhoon5, Marshall L Jacobs6. 1. Department of Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Texas. Electronic address: husain@uhtscsa.edu. 2. Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. 3. Department of Surgery, John Hopkins University, All Children's Hospital, St. Petersburg and Tampa, Florida. 4. Department of Pediatrics, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina. 5. Department of Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Texas. 6. Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND: Geographic variations associated with surgical intervention for congenital heart disease are ill defined. This study uses a large clinical registry to assess frequency of surgical intervention for various infant congenital heart diseases overall and across US geographic regions. METHODS: Patients younger than 1 year of age in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 2010 through June 2012) were included. Index operations were classified on the basis of seven major diagnostic groups and 10 specific diagnoses and were compared across geographic regions using a χ(2) test. Region was defined by patient residence. RESULTS: The study included 23,379 patients (94 centers). Septal defects (26.2%) were the most frequently reported diagnostic group, and tetralogy of Fallot (10.6%) was the most frequent specific diagnosis. Significant geographic variation was noted for all seven major diagnostic groups. The proportion of patients undergoing surgery for septal defects varied from 23.9% to 30.2% (p = 0.001); pulmonary venous anomalies, 2.8% to 4.5% (p = 0.03); right heart lesions, 15.7% to 21.4% (p < 0.0001); left heart lesions, 22.7% to 30.4% (p = 0.0002); single-ventricle lesions, 7.3% to 11.4% (p < 0.0001); transposition of the great arteries and double-outlet right ventricle, 9.0% to 15.3% (p < 0.0001); and coronary artery anomalies, 0.4% to 1.4% (p = 0.04). Significant regional variation was also observed for 7 of the 10 specific diagnoses examined. CONCLUSIONS: These data demonstrate significant variation in congenital heart disease diagnostic groups requiring surgery before 1 year of age across US geographic regions.
BACKGROUND: Geographic variations associated with surgical intervention for congenital heart disease are ill defined. This study uses a large clinical registry to assess frequency of surgical intervention for various infant congenital heart diseases overall and across US geographic regions. METHODS:Patients younger than 1 year of age in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 2010 through June 2012) were included. Index operations were classified on the basis of seven major diagnostic groups and 10 specific diagnoses and were compared across geographic regions using a χ(2) test. Region was defined by patient residence. RESULTS: The study included 23,379 patients (94 centers). Septal defects (26.2%) were the most frequently reported diagnostic group, and tetralogy of Fallot (10.6%) was the most frequent specific diagnosis. Significant geographic variation was noted for all seven major diagnostic groups. The proportion of patients undergoing surgery for septal defects varied from 23.9% to 30.2% (p = 0.001); pulmonary venous anomalies, 2.8% to 4.5% (p = 0.03); right heart lesions, 15.7% to 21.4% (p < 0.0001); left heart lesions, 22.7% to 30.4% (p = 0.0002); single-ventricle lesions, 7.3% to 11.4% (p < 0.0001); transposition of the great arteries and double-outlet right ventricle, 9.0% to 15.3% (p < 0.0001); and coronary artery anomalies, 0.4% to 1.4% (p = 0.04). Significant regional variation was also observed for 7 of the 10 specific diagnoses examined. CONCLUSIONS: These data demonstrate significant variation in congenital heart disease diagnostic groups requiring surgery before 1 year of age across US geographic regions.
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