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Congenital heart surgery is no longer a specialty of small children and infants:analysis of 29 million pediatric discharges *David Ls Morales, Farhan Zafar, Daniel E Graves, Wayne J Franklin, Douglas S Moodie, Charles D Fraser, Jr., Jeffrey F HeinleBaylor College of Medicine, Houston, TX BACKGROUND: The continuing advances in the surgical management of children with congenital heart disease have improved infant survival significantly. However, the nature of congenital heart surgery (CHS) is largely palliative and thus its success results in an ever-increasing number of patients returning for reoperation. Logically, this should cause the cohort of patients undergoing CHS to become progressively older, although this has not been demonstrated comprehensively at a national level. We sought to define trends in pediatric hospitalizations for CHS over the last decade using an inclusive nationwide database. METHODS: A retrospective analysis was performed using the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database, a nationwide database of pediatric hospital discharges designed to provide national estimates. The available data for year 1997, 2000, 2003 and 2006 were reviewed to observe the trends of hospitalization for patients undergoing CHS. All analyses were performed on weighted values. RESULTS: A total 236,801 out of 28,916,338 (0.8%) hospital stays included CHS. Table shows the demographics and the hospital characteristics. Most notable is an increasing trend in number of hospitalizations for CHS, a 49% increase from 1997 to 2006, while mortality has progressively decreased over time (from 5% in 1997 to 3% in 2006) (p <0.001). These hospitalizations are more frequently occurring at teaching hospitals (p <0.001) and larger hospitals (p <0.001). The median age of the cohort undergoing CHS is increasing (1997:2years, 2000:6 years, 2003:8 years and 2006:9 years) (p <0.001), with adolescents as the largest and fastest-growing age group, expanding from 24% to 44% of the total CHS cohort over the study period (p <0.001). This may explain why over the same time period that infants represent a significantly smaller proportion of the CHS cohort (p <0.001) and that CHS is occurring with less frequency at pediatric hospitals (p <0.001). CONCLUSION: The population undergoing CHS has increased over time. The palliative nature of CHS and its decreased mortality results in a population that has increased in age, resulting in the emergence of adolescents and young adults as the dominant cohort requiring CHS. The success of surgical treatment in children with congenital heart disease will continue to shift the patient population undergoing CHS towards adulthood, a paradigm shift for which we must prepare. 
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