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Chylothorax after pediatric cardiac surgery complicates short-term but not long-term outcomes-a propensity matched
Nikoletta R Czobor1, György Roth1, Zsolt Prodán2
1School of PhD Studies, Semmelweis University, Budapest, Hungary.
Insights
Postoperative chylothorax in children after heart surgery is rare but increases resource use. It did not lead to higher mortality or long-term issues in a matched analysis.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Postoperative chylothorax is a rare, serious complication in pediatric cardiac surgery patients.
- It occurs in cardiac intensive care units (ICUs) and necessitates careful management.
- Understanding its characteristics and outcomes is vital for improving patient care.
Purpose of the Study:
- To identify perioperative characteristics of pediatric patients with chylothorax post-cardiac surgery.
- To analyze treatment options, resource utilization, and long-term complications.
- To assess outcomes in younger children (<2 years) using propensity-matched analysis.
Main Methods:
- Retrospective analysis of patients with chylothorax from 2002-2012 at a tertiary cardiac center.
- Evaluation of occurrence, treatments, and long-term outcomes.
- Propensity-matched analysis for patients under 2 years old regarding postoperative complications.
Main Results:
- 48 patients developed chylothorax over 10 years; highest incidence on postoperative day 2.
- Mortality was 14.6%; 5 patients had thromboembolic complications; 11 had genetic abnormalities.
- Chylothorax patients required prolonged ventilation and hospitalization (P<0.05); no recurrence during reoperations.
Conclusions:
- Chylothorax is an uncommon complication associated with increased resource utilization post-pediatric cardiac surgery.
- It did not reoccur during reoperations.
- Propensity-matched analysis showed no increased mortality or long-term complications.
Background:
The occurrence of postoperative chylothorax in children with congenital heart disease is a rare and serious complication in cardiac intensive care units (ICUs). The aim of our study was to identify the perioperative characteristics, treatment options, resource utilization and long term complications of patients having chylothorax after a pediatric cardiac surgery.
Methods:
Patients were retrospectively assessed for the presence of chylothorax between January 2002 and December 2012 in a tertiary national cardiac center. Occurrence, treatment options and long term outcomes were analyzed. Chylothorax patients less than 2 years of age were analyzed using propensity-matched statistical analysis in regard to postoperative complications after discharge.
Results:
During the 10-year period, 48 patients had chylothorax after pediatric cardiac surgery. The highest incidence was observed on the second postoperative day (7 patients, 14.6%). Seven patients (14.6% of the chylothorax population) died. During the follow up period, 5 patients had additional thromboembolic complications (2 had confirmed thrombophilia). Eleven patients had a genetic abnormality (3 had Down's syndrome, 3 had Di-Giorge's syndrome, 1 had an IgA deficiency and 4 had other disorders). During the reoperations (49 cases), no chylothorax occurred. After propensity matching, the occurrence of pulmonary failure (P=0.001) was significantly higher in the chylothorax group, and they required prolonged mechanical ventilation (P=0.002) and longer hospitalization times (P=0.01). After discharge, mortality and neurologic and thromboembolic events did not differ in the matched groups.
Conclusions:
Chylothorax is an uncommon complication after pediatric cardiac surgery and is associated with higher resource utilization. Chylothorax did not reoccur during reoperations and was not associated with higher mortality or long-term complications in a propensity matched analysis.