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Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery
Morgan L Brown1, Luis G Quinonez2, Steven J Staffa1
1Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA, USA.
Insights
Preoperative thyroid dysfunction in children undergoing cardiac surgery did not impact 30-day mortality or other adverse outcomes. This study found no link between abnormal thyroid-stimulating hormone (TSH) levels and surgical results in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Surgical Outcomes Research
Background:
- Thyroid function is often assessed before pediatric cardiac surgery due to concerns about perioperative cardiac impact.
- The association between preoperative thyroid dysfunction and surgical outcomes in this population remains unclear.
Purpose of the Study:
- To investigate the relationship between preoperative thyroid dysfunction and outcomes in pediatric cardiac surgery.
Main Methods:
- A retrospective cohort study was conducted from January 2005 to July 2019 at an academic pediatric hospital.
- Patients under 19 undergoing cardiac surgery with cardiopulmonary bypass and preoperative thyrotropin (TSH) measurement were included.
- Outcomes were compared based on preoperative TSH levels (low, normal, mildly high, moderately high).
Main Results:
- Of 592 patients, 2.5% had low TSH, 58.6% normal, 29.9% mildly high, and 9.0% moderately high.
- Free thyroxine levels were similar across TSH groups.
- Thirty-day mortality and secondary outcomes (extubation time, ICU/hospital stay, operative complications) showed no significant differences among TSH groups.
Conclusions:
- Mild to moderate subclinical hypothyroidism before cardiac surgery in children is not linked to adverse postoperative outcomes.
- Preoperative thyroid function, as indicated by TSH levels, does not appear to significantly affect outcomes in pediatric cardiac surgery patients.
Context:
Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown.
Objective:
Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery.
Methods:
Retrospective cohort study (January 2005 to July 2019).
Setting:
Academic pediatric hospital.
Patients:
All patients <19 years old who underwent cardiac surgery with cardiopulmonary bypass and had thyrotropin (TSH) measured within 14 days preoperatively. Exclusion criteria included neonates (≤30 days), preoperative extracorporeal life support, salvage operations, or transplantation procedures.
Main Outcome Measures:
Subjects were stratified by preoperative TSH concentration (mIU/L): low (<0.5), normal (0.5-5), mildly high (5.01-10), or moderately high (>10). Outcomes were compared among subjects with normal TSH (control) and each group with abnormal TSH concentrations. The primary outcome was 30-day mortality. Secondary outcomes included time to extubation, intensive care unit and hospital length of stay, and operative complications.
Results:
Among 592 patients analyzed, preoperative TSH was low in 15 (2.5%), normal in 347 (58.6%), mildly high in 177 (29.9%), and moderately high in 53 (9.0%). Free thyroxine was measured in 77.4% of patients and was low in 0 to 4.4% of subjects, with no differences among TSH groups. Thirty-day mortality was similar among TSH groups. There were no differences in any secondary outcome between patients with abnormal TSH and patients with normal TSH.
Conclusion:
Preoperative mild to moderate subclinical hypothyroidism was not associated with adverse postoperative outcomes in children undergoing cardiopulmonary bypass procedures.
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