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Noncardiac surgery in children with hypoplastic left heart syndrome
Adalberto Torres1, John DiLiberti, Richard H Pearl
1Division of Critical Care, Department of Pediatrics, University of Illinois College of Medicine and Children's Hospital of Illinois at St Francis Medical Center, Peoria, IL 61637, USA.
Insights
Even minor non-surgical procedures pose significant mortality risks for infants with hypoplastic left heart syndrome (HLHS). This study found no increase in these procedures but confirmed their high mortality rates, urging further research.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Hospital mortality after cardiac repair in hypoplastic left heart syndrome (HLHS) is known.
- Data on mortality after noncardiac surgical procedures in HLHS patients is lacking.
- Concerns exist regarding the frequency and outcomes of noncardiac procedures in young HLHS children.
Purpose of the Study:
- To determine the trend in noncardiac surgical procedures for children under 2 with HLHS from 1988-1997.
- To assess the mortality rate associated with these noncardiac procedures.
- To compare mortality rates between early and late periods (1988-1992 vs. 1993-1997).
Main Methods:
- Retrospective review of 2,457 hospital discharge records for children <2 years with HLHS (1988-1997).
- Focused analysis on HLHS patients undergoing noncardiac surgical procedures.
- Chi-squared test used to compare mortality rates between two 5-year periods.
Main Results:
- Nineteen percent (95% CI, 13%-25%) of 147 HLHS children undergoing noncardiac surgery died.
- No significant change in outcomes was observed between 1988-1992 and 1993-1997.
- The annual rate of noncardiac procedures among HLHS patients did not significantly increase.
Conclusions:
- Noncardiac surgical procedures in young HLHS patients are associated with considerable mortality.
- Despite no increase in procedure frequency, outcomes remain a concern.
- Further investigation into noncardiac surgery outcomes for high-risk congenital heart disease patients is warranted.
Background/Purpose:
Hospital mortality rate among children with hypoplastic left heart syndrome (HLHS) after cardiac repair is well documented, but comparable data after noncardiac, surgical procedures are unknown. The authors hypothesized an increasing number of noncardiac procedures were being performed on children with HLHS, less than 2 years of age, from 1988 to 1997, and that these procedures were associated with a substantial mortality rate.
Methods:
A retrospective review of hospital discharge data for 2,457 children less than 2 years of age with HLHS for 1988 through 1997 was performed. The authors examined the outcomes of HLHS children undergoing only noncardiac surgical procedures during their hospital stay. Differences in hospital mortality rates between 1988 through 1992 versus 1993 through 1997 were assessed using the Chi2 square statistic.
Results:
Nineteen percent of the 147 children with HLHS undergoing noncardiac, surgical procedures died (95% CI, 13% to 25%). Comparing the 2 study periods, there was no significant change in outcome among HLHS children undergoing noncardiac, surgical procedures (78% v. 83%; P >.1). There was no significant difference in the percentage of hospital discharges with noncardiac, surgical procedures performed per year.
Conclusions:
Although children with HLHS were not undergoing an increase in the number of noncardiac surgical procedures performed annually, even minor surgical procedures were associated with considerable mortality. Outcomes after noncardiac surgery in high-risk children with congenital heart disease warrant further investigation.