• Andrew H Smith, Andrew Y Shin, Sarah Tabbutt, Mousumi Banerjee, Wenying Zhang, Santiago Borasino, Justin J Elhoff, J William Gaynor, Nancy S Ghanayem, Sara K Pasquali, James D St Louis, Subhadra Shashidharan, Michael Ruppe, Kurt R Schumacher, Michael Gaies, and John M Costello.
• Division of Cardiac Critical Care Medicine, The Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Fla. Electronic address: asmit356@jhmi.edu.
• J. Thorac. Cardiovasc. Surg. 2023 Apr 1; 165 (4): 15281538.e71528-1538.e7.

ObjectiveThe optimal timing for neonatal cardiac surgery is a potentially modifiable factor that may affect outcomes. We studied the relationship between age at surgery (AAS) and outcomes across multiple hospitals, focusing on neonatal operations where timing appears is not emergency.MethodsWe studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital on or before day of life 2 undergoing selected index cardiac operations. The impact of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup (ie, free of preoperative mechanical ventilation, mechanical circulatory support, or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic complication), and postoperative cardiac intensive care unit and hospital length of stay. Post hoc analyses focused on operations undertaken between day of life 2 and 7.ResultsWe studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not associated with risk adjusted mortality or major morbidity among the entire cohort and the standard risk subgroup. Older AAS, although associated with modest increases in postoperative cardiac intensive care unit and hospital length of stay in the entire cohort, was not associated with hospital length of stay in the standard risk subgroup.ConclusionsAmong select nonemergency neonatal cardiac operations, AAS between day of life 2 and 7 was not found to be associated with risk adjusted mortality or major morbidity. Although delays in surgical timing may modestly increase preoperative resource use, studies of AAS and outcomes not evident at the time of discharge are needed.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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