Early versus delayed surgical correction of malrotation in children with critical congenital heart disease.

Abstract:

PURPOSE:The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). METHODS:Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Interhospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. RESULTS:Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (p<0.0001). Baseline characteristics, including severity of CHD, were similar between the groups. In the delayed group, 27% of patients underwent a Ladd's procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates of mortality and readmission within 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. CONCLUSIONS:In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative.

journal_name

J Pediatr Surg

authors

Sulkowski JP,Cooper JN,Duggan EM,Balci O,Anandalwar S,Blakely ML,Heiss K,Rangel SJ,Minneci PC,Deans KJ

doi

10.1016/j.jpedsurg.2014.10.006

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

86-91

issue

1

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(14)00656-3

journal_volume

50

pub_type

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