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Published on: July 18, 2014
Estimating Surgical Risk in Younger and Older Children With Congenital Heart Disease
Rebecca Miller1, Dmitry Tumin2, Joseph D Tobias3
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Children with congenital heart disease (CHD) face increased surgical risks, especially those under one year old. Older children with CHD undergoing noncardiac surgery show no increased risk of postoperative complications.
Area of Science:
- Pediatric Surgery
- Cardiology
- Public Health
Background:
- Improved management of congenital heart disease (CHD) leads to more children with CHD undergoing noncardiac surgery.
- Previous research on CHD and adverse surgical outcomes yields conflicting results.
- Older children and adolescents with CHD have been less studied in noncardiac surgery contexts.
Purpose of the Study:
- To investigate the association between congenital heart disease (CHD) and adverse outcomes in pediatric noncardiac surgery.
- To determine if increased patient age attenuates the risk of complications in children with CHD undergoing surgery.
- To analyze the impact of CHD severity on surgical outcomes across different pediatric age groups.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program-Pediatric registry for elective noncardiac surgeries in patients aged 0-17 years.
- Classification of CHD status into none, minor, major, or severe categories.
- Multivariable logistic regression to assess the association between CHD status and postoperative complications, stratified by age quintiles (<1, 1-3, 4-8, 9-13, and 14-17 years).
Main Results:
- The study included 131,164 children, with 6420 having minor, 3825 major, and 963 severe CHD.
- Overall complication rate was 9%.
- Children under 1 year with minor, major, or severe CHD had significantly higher odds of postoperative complications (ORs ranging from 1.97 to 4.37).
- No independent association between CHD and postoperative complications was found in older pediatric age groups.
Conclusions:
- Congenital heart disease (CHD) is independently associated with increased postoperative complications only in infants under one year old undergoing noncardiac surgery.
- The risk of adverse surgical outcomes in children with CHD is age-dependent.
- Age is a critical factor in assessing surgical risk for pediatric patients with CHD.
Background:
As management of congenital heart disease (CHD) improves, children with CHD increasingly present for noncardiac surgery. Prior studies report conflicting results on the association between CHD and adverse outcomes in noncardiac surgery. Studies reporting no such association predominantly analyze older children and adolescents. We evaluated whether the association between CHD and adverse surgical outcomes was attenuated by increased age.
Methods:
Patients aged 0-17 y, undergoing elective noncardiac surgery, were identified in the National Surgical Quality Improvement Program-Pediatric registry. CHD status was classified as none, minor, major, or severe. Multivariable logistic regression evaluated the association of CHD status with the occurrence of any postoperative complication for groups defined by quintiles of patient age (<1, 1-3, 4-8, 9-13, and 14-17 y). Specific complications included cardiac arrest, reintubation, infection, renal failure, neurological complication, thromboembolic complication, reoperation, 30-d unplanned revisit, 30-d prolonged hospital stay, and mortality.
Results:
The analysis included 131,164 children, of whom 6420 had minor CHD, 3825 had major CHD, and 963 had severe CHD. The overall rate of complications was 9%. In multivariable analysis, children <1 y old had greater risk of postoperative complications if they had minor (odds ratio [OR] = 1.97; 95% confidence interval [CI]: 1.70, 2.20; P < 0.001), major (OR = 2.58; 95% CI: 2.28, 2.91; P < 0.001), or severe CHD (OR = 4.37; 95% CI: 3.45, 5.54; P < 0.001). In older age groups, however, the presence of CHD was not independently associated with postoperative complications.
Conclusions:
In pediatric noncardiac surgery, an independent association of CHD with postoperative complications was only evident among children <1 y old.
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