Contemporary Management Patterns Of Neonates With Tetralogy Of Fallot Across The United States
Karthik Thangappan, MD1, Farhan Zafar, MD1, David Winlaw, MD2, David Lehenbauer, MD1, James S. Tweddell, MD1, David L. S. Morales, MD1.
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 2Children's Hospital at Westmead, Sydney, Australia.
Objectives: The purpose of this study is to describe evolving management strategies of neonates born with a diagnosis of Tetralogy of Fallot (ToF) over the last several years.
Methods: The Pediatric Health Information System(PHIS) database was used to identify patients 0-1 month old with ToF from 2012-2015. ICD-9 diagnosis and procedure codes were used to identify the ToF diagnosis (excluding pulmonary atresia, CAVC) and procedures.
Results: 2,266 hospitalized neonates were diagnosed with ToF. 17% underwent full repair, 16% surgical systemic-to-pulmonary shunt, 1% percutaneous stent placement(PDA/RVOT), 6% had no intervention but died in-hospital, and 59% had no intervention and discharged. Comparison of demographics between these treatment cohorts is illustrated in Table 1. In-hospital mortality was similar between full repair(6%), shunt(8%), and stent(0%) patients(p=0.280). Regarding hospital region, patients in Northeast were 2x more likely to get a full repair compared to the Midwest(14%) or Southeast(10%). Patients were 2x more likely to get a shunt if they did not present to the Northeast(8%).
Conclusions: As expected, the vast majority of neonates with TOF are discharged with no intervention and one-third undergo an intervention, which surprisingly is evenly divided between complete repair and systemic-to-pulmonary shunt. However, there are significant regional differences in what interventions are performed. For presentation, we will have the same analysis for 2016-2019, however patients will have to be identified by ICD-10 codes requiring new algorithms.
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