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Effect of Trisomy 21 on Postoperative Length of Stay and Non-cardiac Surgery After Complete Repair of Tetralogy of Fallot

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Abstract

Trisomy 21 (T21) is the most common chromosomal abnormality, and is frequently associated with congenital heart disease. Results of previous studies evaluating the effect of T21 on postoperative outcomes and complications following heart surgery have been mixed. Our goal was to determine if T21 is associated with higher frequency of adverse postoperative outcomes following repair of tetralogy of Fallot (TOF). A query of the Pediatric Health Information System was performed for patients who underwent complete repair of TOF from 2004 to 2015. Patients with a genetic syndrome other than T21 and tracheostomy and/or gastrostomy prior to heart surgery were excluded. Two groups were created on the basis of whether patients received a diagnostic code for T21. The adverse outcomes of interest were postoperative mortality, postoperative length of stay (LOS), postoperative gastrostomy, and postoperative tracheostomy. Univariate and Kaplan–Meier analysis were performed to evaluate outcomes. There were a total of 4790 patients; 430 (9%) patients had T21, and 4360 (91%) patients without a genetic diagnosis. There was no significant difference in mortality before discharge between those with and without T21 (2.3% vs 1.4%; p = 0.155). Patients with T21 had longer postoperative LOS (mean of 19.8 days vs 12.4 days; p < 0.001), and higher rates of postoperative gastrostomy (13.3% vs 5.3%; p < 0.02). There was no significant difference between groups for rates of postoperative tracheostomy (1.9% vs 1.2%; p = 0.276). Kaplan–Meier analysis confirmed that patients with T21 had longer postoperative LOS and greater incidence of gastrostomy.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, 1 Children’s Way, Slot 512-3, Little Rock, AR, 72202-3591, USA

    Eric T. Purifoy, Parthak Prodhan & Elijah H. Bolin

  2. Biostatistics Core, Arkansas Children’s Research Institute, 13 Children’s Way, Little Rock, AR, 72202-3591, USA

    Beverly J. Spray & Joe S. Riley

Authors
  1. Eric T. Purifoy
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  2. Beverly J. Spray
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Corresponding author

Correspondence to Eric T. Purifoy.

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Conflict of interest

The authors of this study have no potential conflicts of interest to disclose.

Ethical Approval

This was a retrospective national database study with de-identified information. Research did not involve human participants and did not require informed consent.

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Appendix

Appendix

Inclusions

ICD9 codes

ICD 10 codes

Trisomy 21

758.0

Q90.0, Q90.1, Q90.2, Q90.9

Tetralogy of Fallot

745.2

Q21.3

Repair of tetralogy of Fallot

35.81

 

VSD closure

 

02UM07Z, 02UM08Z, 02QM0ZZ, 02UM0KZ

Relief of right ventricular outflow tract obstruction

 

02NK0ZZ, 02NH0ZZ, 02BK0ZZ, 02UP07Z, 02RH08Z, 027H0ZZ, 02UK07Z, 02UK08Z, 021K0KP, 02UP08Z, 02UK0JZ, 02UP0JZ, 02RH0JZ, 02UH08Z, 02QH0ZZ, 02UP0KZ

Exclusions

ICD9 codes

ICD 10 codes

Congenital heart disease

745, 746, 747, related codes

Q20, Q21, Q22, Q23, Q24, Q25, Q26 related codes

Genetic syndromes other than trisomy 21

757.39,758.1–759.89, 279.11, 783.43, 271.8–288.01

Q91.1-Q99.0, Q87.0, Q87.1, Q03.1, Q85.0, Q87.2, G60.0, Q89.8, Q77.6, Q44.7, Q81.9, Q87.40, H49.819, E88.40-E88.49, E71.310-E71.548, E76.01-E76.29, E72.52, E72.53, E74.4, E74.8, E77.1, D70.0, E80.0, E84, E79.1, E79.8, E85, E80.4, E80.7

Procedure codes

Diagnostic codes

Procedure codes

Tracheostomy

V440, Z930

31.1, 31.21, 31.29, 0B110F4, 0B113F4, 0B114F4, 0B110D-0B114Z4

Gastrostomy

V441, Z931, Z431

43.0, 43.19, 0DH68UZ, 0DH60UZ, 499,440,49,441, 43,246, 44,372, 44,373

  1. For codes listed above without a trailing decimal, all codes within that category were included.

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Purifoy, E.T., Spray, B.J., Riley, J.S. et al. Effect of Trisomy 21 on Postoperative Length of Stay and Non-cardiac Surgery After Complete Repair of Tetralogy of Fallot. Pediatr Cardiol 40, 1627–1632 (2019). https://doi.org/10.1007/s00246-019-02196-y

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  • DOI: https://doi.org/10.1007/s00246-019-02196-y

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