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Postoperative complications and association with outcomes in pediatric cardiac surgery
Hemant S Agarwal1, Karen B Wolfram1, Benjamin R Saville2
1Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr, Children's Hospital at Vanderbilt, Nashville, Tenn.
Insights
Postoperative complications occurred in 43% of pediatric cardiac surgeries, regardless of cardiopulmonary bypass (CPB) use. These complications significantly increased ventilation duration, intensive care unit and hospital stays, and mortality rates.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Pediatric cardiac surgery is complex, with postoperative complications impacting patient outcomes.
- Cardiopulmonary bypass (CPB) is a common but potentially complicating factor in these procedures.
Purpose of the Study:
- To investigate the incidence of postoperative complications in pediatric cardiac surgery patients.
- To determine the association between cardiopulmonary bypass (CPB) use and these complications.
- To evaluate the relationship between complications and established patient outcome measures.
Main Methods:
- A retrospective observational study of 325 consecutive pediatric cardiac surgery patients over one year.
- Analysis of cardiac and extracardiac complications, CPB parameters, and Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) levels.
- Logistic regression to assess risk factors and outcomes including ventilation duration, ICU and hospital stay, and mortality.
Main Results:
- 43% of patients experienced at least one complication; CPB use did not show a statistically significant association with overall complication incidence after adjusting for covariates.
- Longer CPB times, higher RACHS-1 scores, and lower CPB temperatures were linked to more cardiac complications.
- Increased CPB times and higher RACHS-1 scores correlated with more extracardiac complications.
- Postoperative complications were significantly associated with longer mechanical ventilation, pediatric cardiac intensive care unit (PICU) stay, hospital stay, and increased mortality.
Conclusions:
- Postoperative complications are frequent in pediatric cardiac surgery, occurring in 43% of cases, irrespective of CPB use.
- Complications significantly prolong mechanical ventilation, PICU and hospital stays, and are associated with higher mortality.
- While CPB itself wasn't directly linked to overall complication rates, CPB duration and specific parameters influenced complication occurrence.
Objective:
Our primary aim was to study postoperative complications in pediatric cardiac surgery patients and their association with cardiopulmonary bypass (CPB) use. The secondary aim was to evaluate the association of postoperative complications with established outcome measures.
Methods:
A single-institution retrospective observational study was undertaken of consecutive pediatric cardiac surgery patients during a 1-year period. Five cardiac and 15 extracardiac complications were studied. CPB use, CPB parameters, demographics, and Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) levels were evaluated as risk factors for complications. Outcomes, including mechanical ventilation duration, pediatric cardiac intensive care unit stay, hospital stay, and mortality were studied.
Results:
A total of 325 patients were studied: 271 with CPB and 54 without CPB. Of the 325 patients, 141 (43%) had ≥1 complication (95% confidence interval, 38%-49%). Of the 325 patients, 82 (25%) developed cardiac and 120 (37%) developed extracardiac complications. The evidence from logistic regression analysis was insufficient to suggest a relationship between CPB support and the incidence of cardiac or extracardiac complications after adjusting for age, gender, previous sternotomy, and RACHS-1 levels. For patients receiving CPB, longer CPB times, higher RACHS-1 levels, and a lower temperature with CPB were associated with a greater number of cardiac complications (P < .01). Longer CPB times and higher RACHS-1 levels were associated with a greater number of extracardiac complications (P = .006). Postoperative complications were significantly associated with an increased mechanical ventilation duration, pediatric cardiac intensive care unit stay, and hospital stay and mortality (P < .01).
Conclusions:
Postoperative complications occurred in 43% of pediatric cardiac surgeries performed both with and without CPB. The complications were associated with longer mechanical ventilation and pediatric cardiac intensive care unit and hospital stays, and increased mortality.
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