Complex Chronic Conditions Among Children Undergoing Cardiac Surgery

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Complex Chronic Conditions

Background:

• Children with complex chronic conditions (CCCs) utilize significant inpatient resources and face higher mortality risks.
• Non-cardiac comorbidities in pediatric congenital heart surgery patients are not fully understood regarding their impact on outcomes.

Purpose of the Study:

• To investigate the impact of non-cardiac, comorbid complex chronic conditions on outcomes in children undergoing congenital heart surgery.
• To analyze the association of the number and type (genetic vs. non-genetic) of CCCs with mortality, complications, length of stay, and hospitalization charges.

Main Methods:

• Analysis of the Kids' Inpatient Database (1997-2012) for admissions involving congenital cardiac surgery.
• Classification of pediatric patients based on the number and type of complex chronic conditions.
• Multivariate regression models to assess the relationship between CCCs and adverse outcomes, including mortality and high resource utilization.

Main Results:

• An increasing number of CCCs correlated with a higher risk of mortality and complications.
• Genetic CCCs were associated with a protective effect against mortality (OR=0.71).
• Non-genetic CCCs were significant risk factors for mortality (OR=1.62) and high resource utilization, with their prevalence increasing over time.

Conclusions:

• Complex chronic conditions have a differential impact on outcomes in pediatric congenital heart surgery.
• Non-genetic CCCs represent significant risk factors for morbidity and mortality, necessitating tailored pre-surgical planning and counseling.
• Genetic CCCs did not demonstrate an association with adverse outcomes, suggesting distinct pathophysiological roles.