Transposition of the Great Arteries—Outcomes and Time Interval of Early Neonatal Repair

Abstract

Background: This study evaluates the relationship of morbidity and resource utilization with the timing of early neonatal repair of transposition of the great arteries and intact ventricular septum (d-TGA/IVS). Methods: All patients with d-TGA/IVS who underwent arterial switch in the first 14 days of life, between January 2000 and May 2011, were reviewed. Patients undergoing repair at ≤4 days of age were categorized as group I, 5 to 7 days as group II, and 8 to 14 days as group III. Outcomes included mortality, morbidity, and resource utilization. Results: Hospital survival was 69 (98.6%) of 70. The length of stay (LOS) and total charges were lowest in group I—15.5 days compared to group II—18.0 days and group III—23.5 days ( P = .005); group I—US$128,219 compared to group II—US$141,729 and group III—US$217,427 ( P = .0006). Using regression analysis to account for potentially confounding effects of multiple variables and treating time as a continuous variable demonstrated that age at surgery was significantly associated with total LOS ( P = .029), hospital charges ( P = .029) and intensive care unit charges ( P = .002). Younger age at repair was not associated with worse outcomes for any measure of morbidity. Conclusions: Earlier repair of d-TGA/IVS was associated with decreased resource utilization and no detriment to clinical outcomes. Further analysis based on a larger cohort of patients is needed to verify these results that have important implications for improving the value of care.