Rehospitalization Following Neonatal Cardiac Surgery: Risk Factors and Outcomes

Objective The aim of the study is to determine the number and indications of unplanned hospital readmissions and emergency room visits for children with hypoplastic left heart syndrome (HLHS) or transposition of great arteries (TGA). Design This retrospective chart review involved children with HLHS or TGA who underwent neonatal surgical repair in a single Children's Hospital. Statistical analysis (SPSS 22.0) included chi-square test, t-test, and binary logistic regression. Results Our study cohort (n=117) comprised 28 children with HLHS and 89 with TGA who were followed for a mean (standard deviation, SD) duration of 4.7 (3.2) years. Unplanned readmissions (n=153) occurred in 46 (39.3%) children, a mean (SD) number of 1.3 (2.8) for a median (interquartile range, IQR) of 8 (2-28) days per patient. Indications were respiratory (57.5%), gastrointestinal (18.3%), and cardiac (12.4%) in nature. On binary regression, with birth weight, race, and gestational age as covariates, among children with HLHS, increasing gestational age tended to be associated with a lower risk of readmissions (odds ratio [OR] 0.138; 95% confidence interval [CI]: 0.018-1.031, p=0.054]. The mean (SD) number of emergency room visits (n=261) was 3.2 (9.7) in 42 (35.9%) infants for minor illnesses (64%) or gastrointestinal (13.8%) problems. Conclusion The majority of children with HLHS and TGA have unplanned readmissions. Home-care surveillance programs may reduce health-care utilization in this population.