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Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals
Pirouz Shamszad1, Joseph W Rossano2, Bradley S Marino3
1Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA. shamszadp@email.chop.edu.
Insights
Obesity or diabetes mellitus in pediatric cardiac surgery patients increases hospital stays and costs, but not mortality or complications. These conditions lead to longer intensive care unit and overall hospital stays, higher ventilation use, and increased healthcare expenses.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Metabolic Disorders
Background:
- Obesity and diabetes mellitus are increasingly prevalent in pediatric populations.
- Cardiac surgery in children presents unique challenges, and the impact of comorbidities like obesity and diabetes requires thorough investigation.
Purpose of the Study:
- To evaluate the association between obesity or diabetes mellitus and outcomes in pediatric patients undergoing cardiac surgery.
- To analyze the impact of these comorbidities on mortality, surgical complications, hospital resource utilization, and costs.
Main Methods:
- A multi-institutional, matched case-control study utilizing the Pediatric Health Information System database.
- Inclusion of cardiac surgical cases from 2004-2012 in pediatric patients with obesity or diabetes mellitus, matched to controls based on age, sex, race, and Risk Adjustment for Congenital Heart Surgery score.
- Outcome measures included mortality, surgical complications, intensive care unit (ICU) and hospital length of stay (LOS), mechanical ventilation duration, total parenteral nutrition (TPN) use, and hospital charges.
Main Results:
- A total of 629 cases (obesity/diabetes) were matched with 629 controls. Cases had lower median household income.
- Mortality (1.9% vs. 1.9%) and surgical complications (13.5% vs. 12.4%) were similar between groups.
- Cases experienced longer ICU LOS (3 vs. 2 days) and overall hospital LOS (5 vs. 4 days), with higher rates of prolonged mechanical ventilation (>96 hours) and TPN use (7.2% vs. 4.5%). Median hospital charges were significantly higher for cases across clinical, laboratory, pharmacy, and imaging categories.
Conclusions:
- Obesity or diabetes mellitus in pediatric cardiac surgery patients is linked to increased postoperative morbidity, evidenced by longer hospital stays and higher resource utilization.
- Despite similar mortality and complication rates, these comorbidities significantly increase hospital costs.
- These findings highlight the need for proactive management of obesity and diabetes in pediatric cardiac surgery candidates to mitigate postoperative burdens and healthcare expenditures.
Objective:
To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals.
Design:
A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed.
Setting:
Tertiary children's hospitals in the United States.
Patients:
All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score.
Outcome Measures:
Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant.
Results:
Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group ($38,031 [IQR $31,900-$48,844] vs. ($41,896 [IQR $32,854-$56,020], P < .001). Mortality was similar between cases and controls (22% vs. 1.9%, P =.692). Surgical complications occurred similarly between cases and controls (13.5% vs. 12.4%, P = .535). Cases had longer intensive care unit length of stay than controls (3 vs. 2 days, P = .001), resulting in longer overall hospital length of stay (5 vs. 4 days, P < .001). Cases also had a higher odds of undergoing mechanical ventilation for >96 hours (OR 2.0, 95% CI 1.1-3.7) and higher rate of total parenteral nutrition use (7.2% vs. 4.5%, P = .040). Median hospital charges were higher in cases (clinical: $6,696 vs. $5,872; laboratory: $14,168 vs. $12,251; pharmacy: $12,971 vs. $10,426; imaging: $6,259 vs. $5,660; P ≤ .030 for all).
Conclusions:
The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.
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