Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease

Objective: To assess the outcomes and risk factors for morbidity associated with anesthesia and noncardiac surgical procedures in children and adults with congenital heart disease. Design: We conducted a retrospective cohort study of the 6-year period from January 1987 through November 1992 at one of the Mayo-affiliated hospitals in Rochester, Minnesota. Material and Methods: In all children and adults 50 years of age or younger with congenital heart disease who underwent one or more noncardiac surgical or diagnostic procedures and anesthesia, we analyzed the risk factors for 30-day perioperative morbidity and mortality. Results: The overall frequency of complications among the 276 patients who underwent 480 noncardiac surgical procedures and anesthesia was 5.8% (28 of 180), and only I patient died intraoperatively. Major risk factors univariately associated with complications for the first procedures (15 of 276 patients or 5.4%) included the presence of cyanosis (P = 0.002), current treatment for congestive heart failure (P<0.001), poor general health (P<0.001), and younger age at the time of the procedure (P = 0.027). Procedures performed on the respiratory and nervous systems also were associated with high frequencies of complications. Complications in patients undergoing ambulatory surgical procedures were infrequent (1.7%). Conclusion: The frequency of perioperative complications in children and adults who have congenital heart disease and undergo noncardiac surgical procedures and anesthesia is low. Patients who have pulmonary hypertension, congestive heart failure, or cyanosis and children with congenital heart disease who are younger than 2 years of age have an increased frequency of perioperative morbidity.