Down syndrome and postoperative complications after paediatric cardiac surgery: a propensity-matched analysis

Area of Science:

• Cardiology
• Pediatric Surgery
• Genetics

Background:

• Congenital heart disease (CHD) affects approximately 50% of individuals with Down syndrome, often involving endocardial cushion defects.
• Paediatric cardiac surgery is a critical intervention for CHD, but postoperative complications require careful management.

Purpose of the Study:

• To investigate and compare postoperative complications in paediatric patients with and without Down syndrome undergoing cardiac surgery.
• To determine if Down syndrome is an independent risk factor for adverse outcomes after congenital cardiac surgery.

Main Methods:

• Retrospective analysis of perioperative data from 2063 paediatric patients (January 2003-December 2008).
• Data from 129 Down syndrome patients and 1667 non-Down syndrome patients were analyzed before and after propensity matching.
• Propensity matching was used to create comparable groups, resulting in a study population of 222 patients (111 with Down syndrome).

Main Results:

• Before matching, Down syndrome patients had higher rates of low output syndrome, pulmonary complications, and severe infections.
• Down syndrome patients required longer mechanical ventilation and had longer intensive care unit and hospital stays.
• Mortality rates were similar between groups both before and after propensity matching.
• After propensity matching, no significant difference in adverse event rates was observed between the groups.

Conclusions:

• Down syndrome is not associated with an increased risk of mortality following congenital cardiac surgery.
• After propensity matching, complication rates were comparable between paediatric patients with and without Down syndrome.
• These findings suggest that with appropriate risk adjustment, outcomes for Down syndrome patients are similar to their peers.