ORIGINAL ARTICLE Original Article Five-year Analysis of Operative Mortality and Neonatal Outcomes in Congenital Heart Disease James R. Padley, PhD a,e , Andrew D. Cole, B App Sci (Hons) a , Victoria E. Pye, B Med Sci a , Richard B. Chard, FRACS a,e , Ian A. Nicholson, FRACS a,e , Stephen Jacobe, FCICM c,e , David Baines, FANZCA d,e , Nadia Badawi, PhD b,e , Karen Walker, MN b,e , Gabbie Scarfe, MN a , Karen Leclair, MN a , Gary F. Sholler, FRACP a,e and David S. Winlaw, FRACS a,e,∗ a The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia b Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia c Helen MacMillan Paediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, Australia d Department of Anaesthesia, The Children’s Hospital at Westmead, Sydney, Australia e Sydney Medical School, University of Sydney, Australia Background: We sought to compare overall mortality with neonatal outcomes over a five year period to define risk factors for mortality and service development priorities. Methods: A retrospective cohort study of surgical outcomes following repair or palliation of structural congenital heart defects January 2005–2010. We defined mortality according to contemporary international guidelines and classified surgical procedures using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The effect of age and weight at operation on mortality and annual variation in case-complexity and surgeon case-mix were assessed. Subgroup analysis was performed in patients who were ≤30 days at operation (neonates). Results: Overall mortality within 30 days of operation or prior to hospital discharge was 1.3 and 1.9%, respectively. Mortality was higher in neonates (6.8%) and low birth weight infants (≤2.5 kg) (12.1%). Mortality was similar in bypass versus non-bypass procedures (odds ratio 0.74, p = 0.425). Annual mortality rates were consistent despite a marked increase in case-complexity. Neonates overall required longer periods of intensive care support and were more likely to suffer serious complications compared to older children. Age, weight and RACHS-1 score were independent risk factors for mortality on multivariate analysis. In neonates undergoing bypass procedures, only RACHS-1 score was a significant risk factor. Conclusions: This study provides an accurate and contemporary audit of mortality risk associated with congenital heart surgery. Outcomes compare favourably to international benchmarks but highlight the risks of morbidity and mortality associated with neonatal cardiac surgery. (Heart, Lung and Circulation 2011;20:460–467) © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Congenital heart disease; Outcomes; Neonate Introduction S urgical outcomes for children with congenital heart disease have improved over the past decade. Mor- tality rates have decreased overall; however, mortality associated with some complex defects remains high [1]. Surgical outcomes are influenced at many stages of care and depend not only on surgical performance but also on other factors such as the quality of perioperative intensive Received 3 February 2011; accepted 12 March 2011; available online 21 April 2011 ∗ Corresponding author at: The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Tel.: +61 2 9845 3063; fax: +61 2 9845 2613. E-mail address: davidw@chw.edu.au (D.S. Winlaw). care and patient-specific characteristics affecting baseline risk, including organ immaturity [2,3]. Reporting of insti- tutional mortality rates is important to benchmark current outcomes against other published reports, to identify ser- vice development priorities and to inform parents and patients. The Risk Adjustment in Congenital Heart Surgery (RACHS-1) score classifies operations according to levels of complexity based on expert consensus [4]. The RACHS- 1 score adjusts for wide variations in case-mix and has been shown to independently predict in-hospital mortal- ity in large multi-institution databases [4–7]. The main aim of this study was to review our paedi- atric cardiac surgical outcomes over the past five years and to report mortality rates of procedures classified © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. 1443-9506/04/$36.00 doi:10.1016/j.hlc.2011.03.009