Early Postoperative Albumin Administration Contributes to Morbidity After the Fontan Operation
Hayden J Zaccagni1,2, Jeffrey A Alten3,4, David C Cleveland5
1Section of Pediatric Cardiac Critical Care Medicine, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 9100, Birmingham, AL, 35233, USA.
Insights
Early administration of 5% albumin after Fontan operation predicts prolonged chest tube output and hospital stay. Reducing perioperative colloid may decrease morbidity in high-risk patients.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart disease.
- While mortality is low, significant postoperative morbidity, including prolonged chest tube output (PCTO) and prolonged hospital length of stay (PLOS), is common.
- Predicting patients at high risk for these complications early is crucial for optimizing care.
Purpose of the Study:
- To identify early clinical variables that predict prolonged chest tube output (PCTO) and prolonged hospital length of stay (PLOS) after Fontan operation.
- To assess the association between early perioperative interventions and postoperative outcomes.
Main Methods:
- Retrospective analysis of 84 Fontan (extracardiac conduit) operations.
- Multivariate regression and ROC curve analysis to identify predictors of PCTO (≥8 days) and PLOS (≥12 days).
- Key variables examined included 24-hour fluid balance, albumin administration, and inotrope scores.
Main Results:
- Increased administration of 5% albumin within the first 24 hours post-cardiopulmonary bypass (CPB) was independently associated with PLOS.
- Receiving >25 ml/kg of 5% albumin in the first 24 hours predicted PLOS with high sensitivity (93%) and specificity (94%).
- PCTO was also strongly predicted by early albumin administration.
Conclusions:
- Early and aggressive colloid resuscitation, specifically 5% albumin, in the first 24 hours after Fontan operation is a strong predictor of PCTO and PLOS.
- Identifying patients receiving large volumes of albumin early may help identify those at risk for prolonged morbidity.
- Further research is needed to understand the role of colloid resuscitation and to develop strategies to minimize its use and associated complications.
Abstract:
The Fontan operation has low mortality, but is associated with significant postoperative morbidity, including prolonged chest tube output (PCTO), which is associated with prolonged hospital length of stay (PLOS). We sought to identify variables present early in the clinical course that could predict patients at high risk for PCTO and PLOS. Retrospective data were collected on 84 Fontan (extracardiac conduit) operations from 1/2008 to 12/2013 at a single institution. PCTO was defined as ≥8 days (>75th percentile); PLOS was defined as ≥12 days postoperatively (>75th percentile). Multivariate regression was used to determine covariates associated with PCTO and PLOS. Median age was 3.5 years (IQR 3-5); weight was 14.5 kg (IQR 13-17). There was no mortality. LOS was 9 days (IQR 3-11), and duration of chest tube drainage 6 days (IQR 5-8) at 15 ml/kg/day (IQR 9-20). In univariate analysis, only systemic right ventricle, 24-h 5 % albumin administration, 24-h fluid balance, and 12-h inotrope score were associated with PCTO. In multivariate analysis, only 5 % albumin administration in first 24 h (p < 0.001) and PCTO were independently associated with PLOS. ROC curve analysis showed patients receiving >25 ml/kg of 5 % albumin in first 24-h predicted PLOS (94 % specificity, 93 % sensitivity, AUC = 0.95, p < 0.001). Increased colloid in the first 24-h post-CPB strongly predicts PCTO and PLOS after Fontan operation, potentially providing an early identification of a cohort with unfavorable Fontan physiology. A better understanding of the role of colloid resuscitation after Fontan is necessary, and efforts to reduce perioperative colloid administration could decrease hospital morbidity.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management
01:16Kidney Transplant III: Nursing Management
01:25Peritoneal Dialysis III: Nursing Management
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications