Time to Transfer and Hospitalization Duration for Severe Congenital Heart Defects: Implications for Perinatal Regionalization.

Abstract

To estimate the associations between time to transfer and hospitalization duration among neonates with severe congenital heart defects (CHDs). Retrospective, cross-sectional analysis of neonates with severe CHD, 2013-2021, who were reported to the Illinois Department of Public Health. The outcome was hospitalization duration-time from birth to discharge from a surgical center. The exposure was time to transfer (4 categories): birth at a surgical center (referent), not born at a surgical center and transferred at 0, 1-3, or after 3 days. Covariates included clinical and sociodemographic factors. Fine-Gray models estimated subdistribution hazard ratios for discharge, accounting for competing risks. Restricted mean survival time summarized the average hospitalization duration at different timepoint cutoffs. Among 1391 neonates with severe CHD, 48.1% (669/1391) were not born at a cardiac surgical center. Of those who were transferred, 43.4% (203/468) were transferred at 0 days, 43.8% (205/468) were transferred within 1-3 days, and 12.8% (60/468) were transferred after 3 days. The median hospitalization duration was 23 days (IQR, 12-46 days). Compared with birth at a cardiac surgical center, transfer after 3 days was associated with a slower rate of discharge over time (adjusted subdistribution hazard ratio, 0.71; 95% CI, 0.54-0.94) and longer hospitalization duration. For the substantial proportion of neonates with severe CHD who were not born at cardiac surgical centers, late transfer was associated with a longer neonatal hospitalization duration.