Factors Associated with Unplanned Reinterventions and Their Relation to Early Mortality after Pediatric Cardiac Surgery

Abstract Objective Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. Methods Morbidity data were prospectively collected in 5 UK centres between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker and diaphragm plication procedures. Mortality (30-day/6-month) in uRE/no-uRE was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery (PRAiS) score. Results A total of 3090 procedures (2861 patients) were included (median age 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. PRAiS score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were: 2.4% vs 1.3%, 8.9% vs 1% and 17.1% vs 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared to no-uRE (12.2% vs 1.4%, p=0.02, 74 pairs). In the uRE group, 21/25 deaths at 6 months occurred when at least one additional postoperative complication was present. In multivariable analysis, neonatal age (p=0.002), low weight (p=0.009), univentricular heart (p Conclusions Unplanned reinterventions are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the PRAiS risk score. Early mortality was higher after an uRE, independent of preoperative factors, but linked to other postoperative complications.