The following is a summary of the “Timing of reintervention influences survival and resource utilization following first-stage palliation of single ventricle heart disease,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Sengupta, et al.

Numerous factors, such as residual lesions requiring reintervention, affect outcomes following first-stage palliation of single-ventricle heart disease. However, there needs to be more data on when to intervene again. Therefore, they looked at patients who needed unplanned reinterventions after the Norwood operation to see if doing so sooner would improve their in-hospital outcomes. All patients who underwent the Norwood procedure between January 1997 and November 2017 and needed predischarge unplanned surgical or transcatheter reintervention on 1 or more subcomponent areas repaired at the index operation were included in this single-center retrospective review. 

Mortality or transplantation during hospitalization, postoperative length of hospital stay, and inpatient cost were among the outcomes examined. Logistic regression (mortality or transplant) or generalized linear models (postoperative hospital length of stay and cost) were used to examine the associations between the timing of reintervention and outcomes while controlling for baseline patient-related and procedural factors. Around 92 patients (18.4%) out of 500 who underwent the Norwood procedure needed a second operation. The average interval between interventions was 12 days (interquartile range, 5-35 days). The median postoperative hospital stay was 49 days (interquartile range, 32-87 days), and the median cost was $328,000 (interquartile range, $204,000-$464,000). 

There were 31 deaths or transplants (33.7%). Multivariate analysis showed a 20% increase in mortality or transplantation risk for every 5-day delay in reintervention (95% confidence interval: 1.1-1.3; P =.004). Increases in postoperative hospital length of stay and total cost were also significantly correlated with longer times before reintervention (P<.001). Re Interventions that are necessary prior to discharge after the Norwood operation are more likely to improve in-hospital transplant-free survival and resource use if they occur sooner rather than later.

Source: sciencedirect.com/science/article/abs/pii/S0022522322005177