Cancellations in Congenital Heart Disease Operations

Abstract

Background

Although recognized as common, the frequency of and reasons for cancellations of congenital heart disease surgery to our knowledge, has not been described previously.

Methods

Patients with congenital heart disease scheduled for surgical repair from January of 2018 through December of 2023 were reviewed. For patients with multiple scheduled procedures, only the principal surgery was included. Subsequent noncardiac procedures were excluded. Patients’ age at surgery and the Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) score (a measure of operative risk) were recorded. Cancellations were categorized into patient factors and institutional factors.

Results

A total of 729 cases were analyzed. Of these, 220 (30.2%) cases were canceled, including 146/220 (66.4%) cases for patient factors and 74/220 (33.6%) for institutional factors. The most common patient factor contributing to cancellation was a suspected or confirmed viral illness (69/146, 47.3%). The most common institutional factor was an urgent case taking priority (33/74, 44.6%). Cancellations were least common in neonates and STAT 5 procedures but were similar across all other age groups and STAT categories. Cancellations due to patient illness did not show a notable seasonal variation but increased after the COVID-19 pandemic. As surgical volume increased, cancellations related to institutional factors increased.

Conclusion

The most common cause for cancellation of congenital heart disease surgeries is a viral illness. Although neonates and patients needing STAT 5 procedures were the least likely to be canceled, the rate of cancellation was similar across the other age and STAT categories. In a cohort including the COVID 19 pandemic, there was no obvious seasonal variation in cancellations.