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Published on: May 26, 2023
Short operation time: an important element to reduce operative invasiveness in pediatric cardiac surgery
Makoto Ando1, Yukihiro Takahashi, Toshio Kikuchi
1Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Tokyo, Japan. maando@shi.heart.or.jp
Insights
The mini skin incision in pediatric cardiac surgery offers cosmetic benefits but can prolong operation time, increasing surgical insult. Reducing operation time is crucial for minimizing invasiveness and improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Minimally Invasive Surgery
Background:
- Mini skin incisions provide cosmetic advantages in cardiac surgery.
- However, limited exposure may lead to longer operation times and increased surgical insult.
Purpose of the Study:
- To investigate the impact of mini skin incisions on operative outcomes in pediatric cardiac surgery.
- To analyze the relationship between operation time and patient recovery metrics.
Main Methods:
- Retrospective analysis of 357 pediatric patients undergoing septal defect repair with mini skin incisions.
- Risk analyses were performed, particularly on patients weighing less than 5 kg undergoing ventricular septal defect repair.
Main Results:
- Operation time was reduced by 21.0% (93.4 to 73.8 minutes).
- Shorter operation time correlated significantly with faster extubation, shorter intensive care unit (ICU) stay, and reduced furosemide use.
- Incision length did not correlate with any outcome measure.
Conclusions:
- Prolonged operation time with mini skin incisions can increase surgical insult in pediatric cardiac surgery.
- Efforts to reduce or maintain operation time are essential for minimizing invasiveness.
Background:
The mini skin incision procedure is considered an important element of minimally invasive cardiac surgery because of its definitive cosmetic advantage. However, the operative hazard of limited exposure may be associated with prolonged operation time and increased surgical insult.
Methods:
A total of 357 consecutive patients undergoing repair of an isolated atrial or ventricular septal defect, in whom the mini skin procedure was applied, were investigated. Patients were grouped by diagnosis and body weight. Univariate and multivariate risk analyses were conducted in the specific patient group undergoing ventricular septal defect repair weighing less than 5 kg.
Results:
The operation time was reduced by 21.0% (93.4 to 73.8 minutes) during this time period. Univariate risk analysis revealed that the operation time had a significant correlation with time to extubation (p < 0.0001), catecholamine duration (p = 0.0003), intensive care unit stay (p < 0.0001), hospital stay (p = 0.016), arterio-alveolar oxygen tension difference at the time of extubation (p = 0.0253), and furosemide dose required in the first 24 hours (p = 0.0332). Multiple linear regression analysis revealed that the operation time had an impact on time to extubation, arterio-alveolar oxygen tension difference at the time of extubation, and intensive care unit stay. The length of skin incision was not correlated with any outcome measure.
Conclusions:
The mini skin incision, if associated with prolonged operation time, may increase the overall insult in pediatric cardiac surgery. In order to reduce operative invasiveness, simultaneous effort to reduce, or at least not to increase, the operation time are mandatory.
