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Determinants of intensive care unit length of stay for infants undergoing cardiac surgery
Matthew Gillespie1, Marijn Kuijpers, Maike Van Rossem
1Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. gillespie@email.chop.edu
Insights
Factors like preoperative organ dysfunction, need for nasogastric feeding, and total support time predict longer intensive care unit stays in infants after congenital heart surgery. Understanding these can help identify high-risk infants for extended care.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Congenital Heart Disease
Background:
- Infants undergoing congenital heart surgery often require intensive care.
- Predicting length of stay in the pediatric intensive care unit (PICU) is crucial for resource allocation and patient management.
- Identifying factors influencing PICU length of stay (ICULOS) in this vulnerable population is essential.
Purpose of the Study:
- To identify factors influencing postoperative intensive care unit length of stay (ICULOS) in infants under 6 months undergoing congenital heart surgery.
- To establish predictors for extended ICULOS in pediatric cardiac surgery patients.
Main Methods:
- Retrospective review of 221 infants undergoing congenital heart surgery between January 2000 and December 2000.
- Surgical complexity assessed using the Aristotle Basic Complexity Score (ABCS).
- Step-wise multiple regression analysis to identify factors associated with ICULOS.
Main Results:
- Factors associated with longer ICULOS included: increasing ABCS, preoperative organ-system failure, total support time, postoperative ventilatory support duration, need for postoperative cardiac catheterization, necrotizing enterocolitis, and nasogastric feeds.
- Higher preoperative weight and surgical repair (vs. palliation) were associated with decreased ICULOS.
- Nonelective surgery was associated with significantly longer ICULOS and higher mortality compared to elective surgery.
Conclusions:
- Preoperative organ dysfunction, need for nasogastric feeding, and total support time are significant predictors of extended ICULOS.
- These variables can aid in identifying infants at greatest risk for prolonged intensive care.
- Early identification of high-risk infants allows for proactive management and resource planning.
Objective:
The purpose of this study was to identify factors that influence postoperative intensive care unit length of stay (ICULOS) in infants less than 6 months of age undergoing congenital heart surgery.
Methods:
Records from a single institution, from January 2000 to December 2000, were reviewed. For analysis, surgical severity was characterized using an ordinal scoring system, the Aristotle Basic Complexity Score (ABCS; range 1-4).
Results:
Of 221 infants, 63 had elective surgery, that is, admission to the cardiac intensive care unit after surgery, and 158 had nonelective surgery with admission to the cardiac intensive care unit preoperatively. Elective vs. Nonelective groups differed: ABCS (median 2 vs. 3, P < .001), age at surgery (mean 110 + 10.5 vs. 27 + 3.7 days, P < .001), ICULOS (median 3.5 vs. 7 days, P < .000), and mortality (0% vs. 12.7%P < .0001). Step-wise multiple regression was performed using the natural log of ICULOS as the dependent variable. Factors associated with longer ICULOS for all 221 patients included: increasing ABCS, preoperative organ-system failure, total support time (= cardiopulmonary bypass time + deep hypothermic circulatory arrest time), total hours of postoperative ventilatory support, the need for postoperative cardiac catheterization, postoperative necrotizing enterocolitis, and postoperative nasogastric feeds. Higher preoperative weight and surgical repair vs. palliation were associated with a decrease in ICULOS.
Conclusion:
In conclusion, preoperative organ dysfunction, need for nasogastric feeding, and total support time may offer measurable variables useful in predicting that infant at greatest risk for extended ICULOS.
