Martin BJ, et al. – This paper focused on the post–operative outcomes in children undergoing Fontan palliation in a regionalized surgical system. Results represented that children with complex congenital heart disease achieved good outcomes in a regionalized surgical care model, which did not differ according to a patient’s home base.

• This study recruited patients who underwent a Fontan between 1996 and 2016.
• For each patient, follow–up data including length of stay (LOS), repeat surgical interventions, and transplant–free survival were acquired.
• With the aid of Kaplan–Meier survival analysis and Cox proportional Hazards models, the association between post–operative outcomes and home center was evaluated.
• 320 children (median age 3.3 years, IQR 2.8–4.0) were enrolled.
• 120 (37.5%) had the surgical center as their home center.
• In 107 (33.4%) subjects, cardiac anatomy was hypoplastic left heart syndrome.
• Median LOS was 11 days (IQR, 8–17), and there were 8 in–hospital deaths.
• There were 17 deaths and 11 transplants over the course of follow–up.
• 92.5% was the 5–year transplant–free survival.
• No difference in hospital re–intervention, late re–intervention, or survival by referral center was observed (all p > 0.05).
• In multivariable analysis, home center was not predictive of either LOS (R² = –0.40, p = 0.87) or transplant–free survival (1.52, 95%CI 0.66, 3.54).