2014 SCA-IARS Starter Grant

Bryan Maxwell, MD, MPH

Assistant Professor of Anesthesiology and Critical Care Medicine
Johns Hopkins University
Baltimore, Maryland

Dr. Maxwell’s Research

Development of a comprehensive perioperative registry of noncardiac surgery and obstetric care for patients with adult congenital heart disease

Patients with adult congenital heart disease (ACHD) represent a growing and vulnerable population in perioperative medicine, and existing informatics infrastructure has major gaps in providing information to guide the provision, assessment, and improvement of care. Dr. Maxwell’s work under his SCA-IARS grant seeks to address these gaps through the development of new technology.

Related Publications

Decentralization of care for adults with congenital heart disease in the United States: a geographic analysis of outpatient surgery.
Maxwell BG, Maxwell TG, Wong JK.

Guidelines recommend that adults with congenital heart disease (CHD) undergo noncardiac surgery in regionalized centers of expertise, but no studies have assessed whether this occurs in the United States. We hypothesized that adults with CHD are less likely than children to receive care at specialized CHD centers.

Perioperative morbidity and mortality after noncardiac surgery in young adults with congenital or early acquired heart disease: a retrospective cohort analysis of the National Surgical Quality Improvement Program database.
Maxwell BG, Wong JK, Lobato RL.

An increasing number of patients with congenital heart disease survive to adulthood. Expert opinion suggests that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Using the National Surgical Quality Improvement Program database, we identified a cohort of patients aged 18 to 39 years with prior heart surgery who underwent noncardiac surgery between 2005 and 2010. A comparison cohort with no prior cardiovascular surgery was matched on age, sex, race/ethnicity, operation year, American Society of Anesthesiologists physical status, and Current Procedural Terminology code. A study cohort consisting of 1191 patients was compared with a cohort of 5127 patients. Baseline dyspnea, inpatient status at the time of surgery, and a prior operation within 30 days were more common in the study cohort. Postoperative outcomes were less favorable in the study cohort. Observed rates of death, perioperative cardiac arrest, myocardial infarction, stroke, respiratory complications, renal failure, sepsis, venous thromboembolism, perioperative transfusion, and reoperation were significantly higher in the study cohort (P < 0.01 for all). Mean postoperative length of stay was greater in the study cohort (5.8 vs 3.6 days, P < 0.01). Compared with a matched control cohort, young adult patients with a history of prior cardiac surgery experienced significantly greater perioperative morbidity and mortality after noncardiac surgery. A history of prior cardiac surgery represents a marker of substantial perioperative risk in this young population that is not accounted for by the matched variables. These results suggest that adult patients with congenital heart disease are at risk for adverse outcomes and support the need for further registry-based investigations.

Read Dr. Maxwell’s recent publications and articles.