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Association between preoperative respiratory support and outcomes in paediatric cardiac surgery
Elizabeth C Ciociola1, Karan R Kumar1,2, Kanecia O Zimmerman1,2
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Insights
Preoperative respiratory support in children undergoing heart surgery increases the risk of longer hospital stays and death. Understanding these risks can improve patient care and outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Respiratory Support in Congenital Heart Disease
Background:
- Preoperative mechanical ventilation is linked to worse outcomes after congenital heart disease (CHD) surgery.
- Previous research has not comprehensively analyzed the impact of respiratory support mode and timing on these outcomes.
Purpose of the Study:
- To investigate the association between preoperative respiratory support and outcomes in pediatric cardiac surgery.
- To analyze the effects of different respiratory support modes and escalation on mortality, length of stay, and complications.
Main Methods:
- Retrospective analysis of children (<18 years) undergoing cardiac surgery.
- Multivariable regression to assess associations between respiratory support (nasal cannula, HFNC/NIV, IMV) and outcomes.
- Analysis repeated in a neonatal subcohort.
Main Results:
- 40% of children and 79% of neonates received preoperative respiratory support.
- All modes of support, support escalation, and day-of-surgery IMV were linked to longer postoperative length of stay.
- High-flow nasal cannula/noninvasive ventilation (HFNC/NIV) was associated with increased operative mortality in both children and neonates.
Conclusions:
- Preoperative respiratory support is a significant factor associated with prolonged length of stay and increased mortality in pediatric CHD surgery.
- Understanding these associations can inform surgical timing, prognostic discussions, and risk stratification.
Background:
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
Methods:
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
Results:
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2-11.4) and neonates (odds ratio = 8.97, 95% CI 1.31-61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Conclusion:
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
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