Early versus delayed surgical correction of malrotation in children with critical congenital heart disease

Purpose: The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). Methods: Patients with CHDwho underwent cardiac surgery by 1 year of age and hadmalrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Interhospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. Results: Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (pb0.0001). Baseline characteristics, including severity of CHD,were similar between the groups. In the delayed group, 27% of patients underwent a Ladd's procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates ofmortality and readmissionwithin 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. Conclusions: In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative.