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Published on: July 17, 2014
Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease
David I Chu1, Jonathan M Tan2, Peter Mattei3
1Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Children with congenital heart disease (CHD) face increased risks of morbidity and mortality following laparoscopic surgery. Even minor CHD elevates 30-day morbidity, while major or severe CHD significantly raises both mortality and morbidity risks.
Area of Science:
- Pediatric Surgery
- Cardiology
- Surgical Outcomes
Background:
- Congenital heart disease (CHD) affects surgical risk in pediatric patients.
- Laparoscopic surgery is increasingly used in children, but outcomes in those with CHD require further investigation.
Purpose of the Study:
- To assess the association between congenital heart disease (CHD) and postoperative morbidity and mortality in children undergoing laparoscopic surgery.
- To quantify the risks associated with different severities of CHD in this surgical context.
Main Methods:
- A cohort study utilizing the 2013-2014 National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database.
- Propensity score matching was employed to compare outcomes between children with and without CHD, stratified by CHD severity.
- Outcomes analyzed included in-hospital mortality, 30-day mortality, and 30-day morbidity.
Main Results:
- Children with severe CHD exhibited significantly higher overall and 30-day mortality, as well as increased 30-day morbidity, compared to controls.
- Major CHD was also associated with elevated overall mortality and 30-day morbidity.
- Minor CHD did not increase mortality but was linked to higher 30-day morbidity.
Conclusions:
- Laparoscopic surgery in children with major or severe congenital heart disease (CHD) is associated with substantially increased risks of morbidity and mortality.
- These findings underscore the importance of careful risk assessment and clinical decision-making for pediatric surgical candidates with CHD.
Objectives:
To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD).
Study Design:
Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD.
Results:
Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13).
Conclusions:
Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.
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