Risk Factors for Surgical Site Infections Following Adult Spine Operations

2016 ◽  
Vol 37 (12) ◽  
pp. 1458-1467 ◽  
Author(s):  
Ambar Haleem ◽  
Hsiu-Yin Chiang ◽  
Ravindhar Vodela ◽  
Andrew Behan ◽  
Jean M. Pottinger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Prophylaxis ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
University Of Iowa ◽  
Surgical Department ◽  
Spinal Fusions ◽  
Obesity Hypertension

OBJECTIVETo identify risk factors for surgical site infections (SSIs) after spine operations.DESIGNCase-control study of SSIs among patients undergoing spine operations.SETTINGAn academic health center.PATIENTSWe studied patients undergoing spinal fusions or laminectomies at the University of Iowa Hospitals and Clinics from January 1, 2007, through June 30, 2009. We included patients who acquired SSIs meeting the National Healthcare Safety Network definition. We randomly selected controls among patients who had spine operations during the study period and did not meet the SSI definition.RESULTSIn total, 54 patients acquired SSIs after 2,309 spine operations (2.3 per 100 procedures). SSIs were identified a median of 20 days after spinal fusions and 17 days after laminectomies; 90.7% were identified after discharge and 72.2% were deep incisional or organ-space infections. Staphylococcus aureus caused 53.7% of SSIs. Of patients with SSIs, 64.9% (fusion) and 70.6% (laminectomy) were readmitted and 59.5% (fusion) and 64.7% (laminectomy) underwent reoperation. By multivariable analysis, increased body mass index, Surgical Department A, fusion of 4–8 vertebrae, and operation at a thoracic or lumbar/sacral level were significant risk factors for SSIs after spinal fusions. Lack of private insurance and hypertension were significant risk factors for SSIs after laminectomies. Surgeons from Department A were more likely to use nafcillin or vancomycin for perioperative prophylaxis and to do more multilevel fusions than surgeons from Department B.CONCLUSIONSSSIs after spine operations significantly increase utilization of healthcare resources. Possible remediable risk factors include obesity, hypertension, and perioperative antimicrobial prophylaxis.Infect Control Hosp Epidemiol 2016;1458–1467

scholarly journals Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty

2018 ◽  
Vol 128 (4) ◽  
pp. 1241-1249 ◽  
Author(s):  
Kingsley O. Abode-Iyamah ◽  
Hsiu-Yin Chiang ◽  
Nolan Winslow ◽  
Brian Park ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Preventive Measure ◽  
Surgical Site Infections ◽  
Smoking History ◽  
Prosthetic Implants ◽  
Increased Risk ◽  
Vancomycin Powder ◽  
First Time

OBJECTIVECraniectomy is often performed to decrease intracranial pressure following trauma and vascular injuries. The subsequent cranioplasty procedures may be complicated by surgical site infections (SSIs) due to prior trauma, foreign implants, and multiple surgeries through a common incision. Several studies have found that intrawound vancomycin powder (VP) is associated with decreased risk of SSIs after spine operations. However, no previously published study has evaluated the effectiveness of VP in cranioplasty procedures. The purpose of this study was to determine whether intrawound VP is associated with decreased risk of SSIs, to evaluate VP’s safety, and to identify risk factors for SSIs after cranioplasty among patients undergoing first-time cranioplasty.METHODSThe authors conducted a retrospective cohort study of adult patients undergoing first-time cranioplasty for indications other than infections from January 1, 2008, to July 31, 2014, at an academic health center. Data on demographics, possible risk factors for SSIs, and treatment with VP were collected from the patients’ electronic health records.RESULTSDuring the study period, 258 patients underwent first-time cranioplasties, and 15 (5.8%) of these patients acquired SSIs. Ninety-two patients (35.7%) received intrawound VP (VP group) and 166 (64.3%) did not (no-VP group). Patients in the VP group and the no-VP group were similar with respect to age, sex, smoking history, body mass index, and SSI rates (VP group 6.5%, no-VP group 5.4%, p = 0.72). Patients in the VP group were less likely than those in the no-VP group to have undergone craniectomy for tumors and were more likely to have an American Society of Anesthesiologists physical status score > 2. Intrawound VP was not associated with other postoperative complications. Risk factors for SSI from the bivariable analyses were diabetes (odds ratio [OR] 3.65, 95% CI 1.07–12.44), multiple craniotomy procedures before the cranioplasty (OR 4.39, 95% CI 1.47–13.18), prior same-side craniotomy (OR 4.73, 95% CI 1.57–14.24), and prosthetic implants (OR 4.51, 95% CI 1.40–14.59). The multivariable analysis identified prior same-side craniotomy (OR 3.37, 95% CI 1.06–10.79) and prosthetic implants (OR 3.93, 95% CI 1.15–13.40) as significant risk factors for SSIs. After adjusting for potential confounders, patients with SSIs were more likely than those without SSIs to be readmitted (OR 7.28, 95% CI 2.07–25.60).CONCLUSIONSIn this study, intrawound VP was not associated with a decreased risk of SSIs or with an increased risk of complications. Prior same-side craniotomy and prosthetic implants were risk factors for SSI after first-time cranioplasty.

Risk Factors for Spinal Surgical Site Infection, Houston, Texas

2009 ◽  
Vol 30 (9) ◽  
pp. 884-889 ◽  
Author(s):  
Kelley M. Boston ◽  
Sarah Baraniuk ◽  
Shana O'Heron ◽  
Kristy O. Murray
Keyword(s):  
Risk Factors ◽  
Spinal Surgery ◽  
Povidone Iodine ◽  
Smoking Status ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Factors Associated ◽  
Surgical Duration ◽  
Study Hospital

Objective.Because of an increase in the rate of surgical site infections (SSIs) following spinal procedures at the study hospital, we conducted a study to determine risk factors associated with the development of a SSI.Design.Case-control study.Setting.A community hospital in Houston, Texas, with more than 500 beds.Patients.Fifty-five case patients who developed SSI after spinal surgery and 179 control patients who did not develop SSI after spinal surgery.Methods.We examined patient- and hospital-associated risk factors for SSI by using existing data on patients who underwent spinal operations at the study hospital between December 2003 and August 2005. Multivariable analysis was conducted using logistic regression to determine significant risk factors associated with SSI.Results.The presence of comorbidities (odds ratio [OR], 3.15 [95% confidence interval (CI), 1.20-8.26]) and surgical duration greater than the population median of 100 minutes (OR, 2.48 [95% CI, 1.12-5.49]) were identified as independent risk factors for SSI. The use of only povidone-iodine for preoperative skin antisepsis was found to be protective (OR, 0.16 [95% CI, 0.06-0.45]). Specific operating room, hospital staff involved in the procedures, workers' compensation status, method of hair removal, smoking status, or incontinence were not statistically significant.Conclusions.The presence of comorbidities and increased surgical duration are risks for postoperative infection. The use of only povidone-iodine was found to decrease the risk of infection.

scholarly journals Incidence and perioperative risk factors for surgical site infections in neurosurgery: prospective observational study

2022 ◽  
Vol 37 (1) ◽  
Author(s):  
Assem Mouneir Abdel-Latif ◽  
Amira A. Moharram ◽  
Ahmed Higazy ◽  
Nehal I. Ghoneim ◽  
Omnia Shafei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Prophylaxis ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Csf Leak ◽  
Neurosurgical Procedures ◽  
Trauma Patients ◽  
Contributing Factors

Abstract Background Surgical site infections (SSI) represent a burden on the health care system especially in developing countries with significant morbidity and mortality. In Egypt, especially in our institution, there is no registry for the SSI rate or the contributing factors with no clear guidelines regarding the regimen of perioperative antibiotic prophylaxis. Our study was conducted to assess the local practice and to calculate the rate and risk factors of SSI. Patients and methods A prospective registry was established at the Neurosurgery Department, Demerdash teaching hospital Ain Shams University, Cairo, Egypt. All patients who underwent elective neurosurgical procedures were included in this study. Trauma patients were excluded. Patients were followed-up for incident SSI for 1 month postoperatively. SSIs were identified based on CDC criteria and a standardized data collection form predictor variables including patient characteristics, preoperative, intraoperative, and postoperative factors along with the pattern of antimicrobial prophylaxis. Results The study included 248 patients with 1-month postoperative follow-up. An SSI rate of 19% was recorded being mainly in patients below 10 years of age. Postoperative CSF leak was noticed to be the most significant risk factor of SSI in our study (p value < 0.01). Sixty five percent of culture results showed infection with gram-negative bacilli with the predominance of Acinetobacter. Conclusion Prolonged use of perioperative antibiotics does not seem to have an added benefit in SSI prevention. Tailoring of the used antibiotic regimen is highly recommended according to the latest antimicrobial prophylaxis guidelines and the local culture and sensitivity results.

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

scholarly journals Risk factors for hospital readmission following complicated urinary tract infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tanya Babich ◽  
Noa Eliakim-Raz ◽  
Adi Turjeman ◽  
Miquel Pujol ◽  
Jordi Carratalà ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Condition ◽  
Hospital Readmissions ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Complicated Urinary Tract Infection ◽  
Negative Influence

AbstractHospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Deep Spinal Infection after Outpatient Epidural Injections for Pain: A Retrospective Sample Cohort Study Using a Claims Database in South Korea

2021 ◽  
Author(s):  
Chang-Soon Lee ◽  
Young Jae Park ◽  
Jee Youn Moon ◽  
Yong-Chul Kim
Keyword(s):  
Risk Factors ◽  
South Korea ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Epidural Injection ◽  
Spinal Infection ◽  
Single Shot ◽  
Epidural Injections ◽  
Spinal Infections

Background Deep spinal infection is a devastating complication after epidural injection. This study aimed to investigate the incidence of deep spinal infection primarily after outpatient single-shot epidural injection for pain. Secondarily, this study assessed the national trends of the procedure and risk factors for said infection. Methods Using South Korea’s National Health Insurance Service sample cohort database, the 10-yr national trend of single-shot epidural injections for pain and the incidence rate of deep spinal infection after the procedure with its risk factors were determined. New-onset deep spinal infections were defined as those occurring within 90 days of the most recent outpatient single-shot epidural injection for pain, needing hospitalization for at least 1 night, and receiving at least a 4-week course of antibiotics. Results The number of outpatient single-shot epidural injections per 1,000 persons in pain practice doubled from 40.8 in 2006 to 84.4 in 2015 in South Korea. Among the 501,509 injections performed between 2007 and 2015, 52 cases of deep spinal infections were detected within 90 days postprocedurally (0.01% per injection). In multivariable analysis, age of 65 yr or more (odds ratio, 2.91; 95% CI, 1.62 to 5.5; P = 0.001), living in a rural area (odds ratio, 2.85; 95% CI, 1.57 to 5.0; P &lt; 0.001), complicated diabetes (odds ratio, 3.18; 95% CI, 1.30 to 6.7; P = 0.005), multiple epidural injections (three times or more) within the previous 90 days (odds ratio, 2.34; 95% CI, 1.22 to 4.2; P = 0.007), and recent use of immunosuppressants (odds ratio, 2.90; 95% CI, 1.00 to 6.7; P = 0.025) were significant risk factors of the infection postprocedurally. Conclusions The incidence of deep spinal infection after outpatient single-shot epidural injections for pain is very rare within 90 days of the procedure (0.01%). The data identify high-risk patients and procedure characteristics that may inform healthcare provider decision-making. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcia M. L. Kho ◽  
Stefan Roest ◽  
Dominique M. Bovée ◽  
Herold J. Metselaar ◽  
Rogier A. S. Hoek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Multivariable Analysis ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Clinical Signs ◽  
Significant Risk ◽  
Solid Organ ◽  
Disseminated Disease ◽  
Cmv Prophylaxis

BackgroundStudies on herpes zoster (HZ) incidence in solid organ transplant (SOT) recipients report widely varying numbers. We investigated HZ incidence, severity, and risk factors in recipients of four different SOTs, with a follow-up time of 6–14 years.MethodsRecords of 1,033 transplant recipients after first heart (HTx: n = 211), lung (LuTx: n = 121), liver (LiTx: n = 258) and kidney (KTx: n = 443) transplantation between 2000 and 2014 were analyzed for VZV-PCR, clinical signs of HZ, and complications.ResultsHZ was diagnosed in 108 of 1,033 patients (10.5%): 36 HTx, 17 LuTx, 15 LiTx, and 40 KTx recipients. Overall HZ incidence rate after HTx (30.7 cases/1,000 person–years (PY)), LuTx (38.8 cases/1,000 PY), LiTx (22.7 cases/1,000 PY) and KTx (14.5 cases/1,000 PY) was significantly higher than in the general 50–70 year population. Multivariable analysis demonstrated age ≥50 years at transplantation (p = 0.038, RR 1.536), type of organ transplant (overall p = 0.002; LuTx p = 0.393; RR 1.314; LiTx p = 0.011, RR 0.444; KTx p = 0.034, RR 0.575), CMV prophylaxis (p = 0.043, RR 0.631) and type of anti-rejection therapy (overall p = 0.020; methylprednisolone p = 0.008, RR 0.475; r-ATG p = 0.64, RR1.194) as significant risk factors. Complications occurred in 33 of 108 (31%) patients (39% of HTx, 47% of LuTx, 20% of LiTx, 20% of KTx): post-herpetic neuralgia, disseminated disease, and cranial nerve involvement.ConclusionHZ incidence and severity in SOT recipients are most pronounced after heart and lung transplantation, in older patients, and when CMV prophylaxis is lacking.

scholarly journals Analysis of risk factors associated with caesarean section surgical site infections: a case control study

2020 ◽  
Vol 9 (12) ◽  
pp. 5075
Author(s):  
Riya Rano ◽  
Purvi K. Patel
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Subcutaneous Tissue ◽  
White Blood Cells ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Factors Associated ◽  
Operative Care ◽  
Duration Of Surgery

Background: Surgical site infection (SSI) is defined as infection occurring within 30 days after a surgical procedure and affecting either the incision or deep tissues at the operation site. SSIs are the most common nosocomial infections, accounting for 38% of hospital-acquired infections. Despite the advances in SSI control practices, SSIs remain common causes of morbidity and mortality among hospitalized patients. This study was undertaken with an objective to determine and analyze the risk factors associated with cesarean section SSIs.Methods: The study was carried out at Medical College and SSG Hospital, Baroda. After obtaining informed consent to be a part of the study, 140 subjects having cesarean section SSI as per the definition, were included as cases in the study. The controls (140) were also selected from the hospital subjects. The primary post-operative care was similar for the cases as well as controls. For patients who had SSI, samples of discharge from the cesarean section wound were collected and transported for culture. Antibiotics were given accordingly. Details about patient characteristics and outcomes were collected in the proforma for cases and controls and data analyzed.Results: The cesarean section SSI rate was 4.78%. Of the parameters studied, maternal age, parity, gestational age, HIV status, meconium stained amniotic fluid, amount of blood loss, previous surgery, duration of surgery were not associated with cesarean section SSI.Conclusions: Number of antenatal care (ANC) visits, haemoglobin, total white blood cells (WBC) count, pre eclampsia, premature rupture of membranes (PROM), non-progression in 2nd stage and subcutaneous tissue thickness were the independent significant risk factors associated with post-cesarean SSI.

Preoperative in-hospital mortality in neonates with critical CHD

2021 ◽  
pp. 1-7
Author(s):  
Dennis R. Delany ◽  
Shahryar M. Chowdhury ◽  
Corinne Corrigan ◽  
Jason R. Buckley
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Patient Care ◽  
Multivariable Analysis ◽  
Health Information System ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Interrupted Aortic Arch ◽  
Administrative Dataset ◽  
Care Improvement

Abstract Objective: Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. Study design: The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. Results: Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. Conclusion: Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

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