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J Thorac Cardiovasc Surg 2009;138:397-404
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle

Jeffrey B. Anderson, MD, MPHa,*, Robert H. Beekman, III, MDa, William L. Border, MBChB, MPHa, Heidi J. Kalkwarf, PhDd, Philip R. Khoury, MSa, Karen Uzark, PhDa, Pirooz Eghtesady, MD, PhDb, Bradley S. Marino, MD, MPP, MSCEa,c

a Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
b Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
c Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
d Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Received for publication September 29, 2008; revisions received December 15, 2008; accepted for publication February 16, 2009.

* Address for reprints: Jeffrey B. Anderson, MD, MPH, Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML2003, Cincinnati, OH 45259. (Email: jeffrey.anderson{at}cchmc.org).

Objective: Poor growth has been described in infants with a single ventricle; however, little is known regarding its effect on surgical outcomes. We sought to assess the effect of nutritional status at the time of the bidirectional Glenn procedure on short-term outcomes.

Methods: We performed a retrospective case series of children who underwent the bidirectional Glenn procedure at our institution between January 2001 and December 2007. Anthropometric measurements were recorded at the time of neonatal admission and the bidirectional Glenn procedure. Data from preoperative echocardiograms and cardiac catheterization were recorded. The primary outcome variable was length of hospital stay.

Results: Data on 100 infants were included for analysis. Age at the time of the bidirectional Glenn procedure was 5.1 months (range, 2.4–10 months). The median weight-for-age z score at birth was –0.4 (range, –2.6 to 3.2), and by the time of the bidirectional Glenn procedure, it had decreased to –1.3 (range, –3.9 to 0.6). In multivariable modeling longer postoperative hospital stays were predicted by lower weight-for-age z score (P = .02), younger age (P < .001), being fed through a gastrostomy tube (P = .01), and undergoing concomitant aortic arch reconstruction (P < .001) at the time of the bidirectional Glenn procedure.

Conclusions: There is suboptimal weight gain between neonatal discharge and the bidirectional Glenn procedure. A lower weight-for-age z score and younger age at the time of the bidirectional Glenn procedure affects length of hospital stay independent of hemodynamic or echocardiographic variables.

Abbreviations and Acronyms BDG = bidirectional Glenn; CHD = congenital heart disease; HLHS = hypoplastic left heart syndrome; WAZ = weight-for-age z score






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