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Associations Between Unplanned Cardiac Reinterventions and Outcomes After Pediatric Cardiac Operations

John M Costello1, Michael C Mongé2, Kevin D Hill3

  • 1Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The Annals of Thoracic Surgery
|February 6, 2018
PubMed

Insights

Unplanned cardiac reinterventions after pediatric heart surgery occur in 5.4% of patients, especially neonates. These reinterventions increase operative mortality and hospital stay, highlighting the need for risk identification.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease
  • Healthcare Quality Improvement

Background:

  • Pediatric heart operations carry risks of complications requiring further intervention.
  • Understanding the incidence and predictors of unplanned cardiac reinterventions is crucial for improving patient outcomes.
  • Previous studies have not comprehensively assessed risk factors and outcomes associated with these reinterventions.

Purpose of the Study:

  • To determine the incidence of unplanned cardiac reinterventions in pediatric heart surgery patients.
  • To identify risk factors associated with unplanned cardiac reinterventions.
  • To explore the impact of reinterventions on operative mortality and postoperative length of stay (PLOS).

Main Methods:

  • Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 2010 to June 2015).
  • Inclusion of patients aged 18 years or younger undergoing cardiac operations.
  • Multivariable regression used to assess risk factors for reintervention and its association with outcomes.

Main Results:

  • Unplanned cardiac reinterventions occurred in 5.4% of 84,404 patients, with higher rates in neonates (11.8%).
  • Independent risk factors included noncardiac anomalies, younger age, lower weight, prior operations, and preoperative ventilation.
  • Reintervention was a significant risk factor for operative mortality (aOR 5.3) and longer PLOS (aRR 2.3).

Conclusions:

  • Unplanned cardiac reinterventions are common, particularly in neonates, and significantly increase operative mortality and PLOS.
  • Preoperative identification of high-risk patients can facilitate targeted quality improvement initiatives.
  • These findings underscore the importance of optimizing perioperative care to minimize reinterventions.
Abstract

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