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Children with heart disease: Risk stratification for non-cardiac surgery
Angela K Saettele1, Jacob L Christensen1, Kelly L Chilson1
1Washington University Department of Anesthesiology, 660 South Euclid, Campus Box 8054, Saint Louis, MO, 63110, USA.
Insights
A new tool effectively stratifies pediatric patients with heart conditions into low, moderate, and high risk categories for anesthesia. This aids in planning care and assigning appropriate staff for non-cardiac surgeries.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Risk Management
Background:
- Children with heart disease face higher risks during anesthesia.
- Anesthetic risk is influenced by cardiac disease severity, comorbidities, and surgical procedures.
Purpose of the Study:
- To assess the usability of a preoperative risk stratification tool for pediatric cardiac staff.
- To determine the frequency of low, moderate, and high-risk pediatric cardiac patients undergoing non-cardiac surgery.
Main Methods:
- A risk-stratification tool was prospectively applied to children with congenital heart disease.
- 100 children undergoing non-cardiac surgery were categorized into risk groups.
- Perioperative records were reviewed for demographic and clinical data.
Main Results:
- Out of 100 children with cardiac disease, 23 were low risk, 66 moderate risk, and 11 high risk.
- Pediatric cardiac anesthesiologists managed all high-risk patients.
- No serious adverse events occurred during the study period.
Conclusions:
- The risk stratification tool effectively differentiates children into risk categories for anesthesia planning.
- This method assists in assigning appropriate staff and managing preoperative expectations.
Study Objective:
Children with congenital or acquired heart disease have an increased risk of anesthesia related morbidity and mortality. The child's anesthetic risk is related to the severity of their underlying cardiac disease, associated comorbidities, and surgical procedure. The goal of this project was to determine the ease of use of a preoperative risk stratification tool for assigning pediatric cardiac staff and to determine the relative frequency that children with low, moderate, and high risk cardiac disease present for non-cardiac surgery at a tertiary pediatric hospital.
Design:
A risk-stratification tool was prospectively applied to children with congenital heart disease who presented for non-cardiac surgery.
Setting:
Perioperative.
Patients:
We identified a subset of 100 children with congenital heart disease out of 2200 children who required general anesthesia for surgical or radiological procedures over a 6 week period.
Interventions:
A risk stratification tool was utilized to place the patient into low, moderate, or high risk categories to help predict anticipated anesthetic risk. Each grouping specified assignment of staff caring for the patient, clarified preoperative expectations for cardiac assessment, and determined if patient care could be performed at our freestanding ambulatory surgical center.
Measurements:
Electronic perioperative records were reviewed to obtain demographic information, the underlying heart disease, prior cardiac surgery, associated conditions, anesthetic management, complications, and provider type.
Main Results:
Approximately 4.5% of children presented with cardiac disease over a 6 week period. In 100 consecutive children with cardiac disease, 23 of the children were classified as low risk, 66 patients were classified as moderate risk, and 11 of the patients were classified as high risk. Pediatric cardiac anesthesiologists provided care to all high risk patients. There were no serious adverse events.
Conclusions:
We found this risk stratification method an effective method to differentiate children into low, moderate, and high risk categories for anesthesia planning and management.
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