Textbook Outcome for the Fontan Operation: A Holistic Quality Metric in Congenital Heart Surgery.
| Title: | Textbook Outcome for the Fontan Operation: A Holistic Quality Metric in Congenital Heart Surgery. |
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| Authors: | Cook JK; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Ghandour H; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Singh ES; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Foster JA; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Prabhu NK; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Mensah-Mamfo M; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Moya-Mendez ME; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Medina CK; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Thornton SW; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Overbey DM; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Duke Children's Pediatric and Congenital Heart Center, Durham, NC, USA.; Turek JW; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA.; Duke Children's Pediatric and Congenital Heart Center, Durham, NC, USA. |
| Source: | Innovations (Philadelphia, Pa.) [Innovations (Phila)] 2025 Sep-Oct; Vol. 20 (5), pp. 464-471. Date of Electronic Publication: 2025 Oct 13. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: SAGE Publications Country of Publication: United States NLM ID: 101257528 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1559-0879 (Electronic) Linking ISSN: 15569845 NLM ISO Abbreviation: Innovations (Phila) Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2019- : [Thousand Oaks, CA] : SAGE Publications; Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins |
| MeSH Terms: | Heart Defects, Congenital*/mortality ; Heart Defects, Congenital*/surgery ; Fontan Procedure*/adverse effects ; Fontan Procedure*/economics ; Fontan Procedure*/standards ; Fontan Procedure*/statistics & numerical data ; Outcome Assessment, Health Care*/methods ; Postoperative Complications*/economics ; Postoperative Complications*/etiology ; Postoperative Complications*/mortality ; Quality Improvement*/economics ; Quality Improvement*/statistics & numerical data; Hospital Costs/statistics & numerical data ; Length of Stay/economics ; Length of Stay/statistics & numerical data ; Patient Readmission/economics ; Patient Readmission/statistics & numerical data ; Prognosis ; Retrospective Studies ; Humans ; Male ; Female ; Infant, Newborn ; Infant ; Child, Preschool ; Kaplan-Meier Estimate ; Logistic Models ; Treatment Outcome ; Risk Factors |
| Abstract: | Objective: To develop a holistic measure of congenital heart center performance, we created a composite "textbook outcome" (TO) for the Fontan operation using postoperative endpoints. We hypothesized that achieving the TO would have a positive prognostic and financial impact.; Methods: This was a single-center study of primary Fontan operations from 2005 to 2022. TO was defined as freedom from operative mortality, reintervention, 30-day readmission, extracorporeal membrane oxygenation, major thrombotic complication, chylothorax, >75th percentile length of stay, and >75th percentile mechanical ventilation duration. Multivariable logistic regression and Kaplan-Meier survival analysis were used to assess statistical significance.; Results: Overall, 49% of patients (97 of 198) met the TO. Patients who failed to achieve the TO were more likely to have a dominant right ventricle, moderate-severe regurgitation of the systemic atrioventricular valve, and higher pulmonary vascular resistance. In the multivariable analysis, the presence of pulmonary artery (PA) stenosis, higher mean PA pressure, and Norwood as the index operation were independently associated with a lower likelihood of achieving the TO. However, a history of atrial septostomy prior to Fontan was independently associated with a 3-fold higher likelihood of achieving the TO. Patients who met the TO acquired lower median direct hospital costs ($40,800 vs $80,400, P < 0.001) and had higher long-term survival (log rank, P = 0.027).; Conclusions: Fontan TO achievement is associated with increased long-term survival and lower costs and can be predicted by certain risk factors. As outcomes continue to improve within congenital heart surgery, operative mortality alone becomes a less-sensitive metric. The Fontan TO may represent a balanced measure of successful patient care. |
| Competing Interests: | Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: CHD; Fontan; hypoplastic left heart syndrome; mortality; univentricular heart |
| Entry Date(s): | Date Created: 20251030 Date Completed: 20251209 Latest Revision: 20251209 |
| Update Code: | 20260130 |
| DOI: | 10.1177/15569845251375441 |
| PMID: | 41166084 |
| Database: | MEDLINE |
Journal Article