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Surgical management was established from the listed procedure codes. This was unambiguous for cardiac transplantation (37.5). Because there is no specific ICD-9 code for the Norwood or Sano procedure, patients were considered to have undergone an S1P if they had any of the TRIB1 following procedure codes: surgical creation of a septal defect (34.42), systemic-to-pulmonary artery shunt (39.0), right ventricle-to-pulmonary artery conduit (35.92), or repair of the heart and pericardium (37.4). Patients coded as having resection, excision, or repair of the aorta (38.34�C38.85) were considered to have S1P if there was also cardiopulmonary bypass (39.61) on the same date. Otherwise, they were categorized as repair of coarctation of the aorta. Patients with codes for repair of atrial septal defect (35.51�C35.52), ventricular septal defect (35.53), endocardial cushion defect (35.54), or total anomalous pulmonary venous return (35.82) without concomitant shunt procedures were considered to have undergone biventricular repair. Patients between 30 days and 1 year of age undergoing caval-pulmonary artery anastomosis (39.21) were considered to have undergone S2P of either the bidirectional Glenn or hemi-Fontan type. Those over 1 year undergoing procedures with MK-2206 bypass and atrial-pulmonary artery conduits (35.94) were considered to have received S3P. Patients with codes for total repair of transposition of the great arteries, tetralogy of Fallot, or truncus arteriosus (a total of eight) were excluded from further analysis. Comorbid conditions were established by the presence of ICD-9 diagnosis codes in addition to HLHS. Specifically, the database was queried for the ICD-9 diagnosis codes of prematurity (765.00�C765.28), chromosomal anomalies (758.0�C758.9, 279.11), double outlet right ventricle (745.11), and endocardial cushion defects (745.6, currently referred to as atrioventricular septal defect). In order to evaluate the effect of institutional volume on operative mortality, hospitals were arbitrarily categorized as small, medium, or large according to the number of surgical procedures for HLHS performed during the 10-year study period. Small volume was defined as less than 20 procedures, moderate as 20�C64 procedures, and large as more than 64 procedures. Categories were determined independently Ibrutinib for S1P, S2P, and S3P. To investigate mortality by surgical era, hospital admissions were categorized by date of procedure for S1P, S2P, and S3P. The early era consisted of operations performed during the first 5 years of the study (1998�C2002), and the later era consisted of operations in the last 5 years of the study (2003�C2007). Outcomes were determined by discharge status. Patients were classified as expired, transferred (to another health-care facility), or discharged (to home or hospice care). All analyses were performed utilizing SAS? Version 9.1 (SAS Institute Inc., Cary, NC, USA); statistical significance was defined as a P value
