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Risk Factors for Perioperative Morbidity in Adults Undergoing Cardiac Surgery at Children's Hospitals
Parag N Jain1, Katherine B Salciccioli2, Danielle Guffey3
1Section of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
Insights
Adults with congenital heart disease undergoing surgery in children's hospitals face high risks. Preoperative factors like renal dysfunction and complex surgeries increase complications and prolonged intensive care unit stays.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease (ACHD)
- Pediatric Cardiac Surgery
Background:
- Growing number of adults with congenital heart disease (ACHD) receive care in pediatric hospitals.
- Limited data exists on surgical outcomes for ACHD patients in these settings.
Purpose of the Study:
- To identify preoperative risk factors impacting postoperative complications.
- To understand factors influencing cardiac intensive care unit (CICU) length of stay (LOS) in ACHD patients.
Main Methods:
- Analysis of 1764 surgical CICU admissions for patients aged 18+ from the Pediatric Cardiac Critical Care Consortium registry (2014-2019).
- Primary outcomes: prolonged LOS (≥90th percentile) and major complications (e.g., cardiac arrest, ECMO, reoperation).
Main Results:
- 8.8% of admissions had prolonged LOS (≥7 days); 23.3% experienced major complications.
- Independent risk factors for prolonged LOS and complications included high-complexity surgery (STS-EACTS 4/5), ≥3 sternotomies, and preoperative renal dysfunction/dialysis.
- Preoperative ventilation and arrhythmia were also associated with adverse outcomes.
Conclusions:
- High-complexity operations, multiple sternotomies, and preoperative organ dysfunction (renal, respiratory) are linked to prolonged CICU stays and complications in ACHD patients.
- Future efforts should focus on optimizing patients preoperatively and implementing adult-specific protocols in pediatric centers.
Background:
Increasing numbers of adults with congenital heart disease (ACHD) undergo cardiac surgical procedures in children's hospitals, yet surgical outcomes data are limited. We sought to better understand the impact of preoperative risk factors on postoperative complications and cardiac intensive care unit (CICU) length of stay (LOS).
Methods:
Surgical CICU admissions for patients aged 18 years and older in the Pediatric Cardiac Critical Care Consortium registry from August 2014 to January 2019 in 34 hospitals were included. Primary outcomes included prolonged LOS (defined as LOS ≥90th percentile) and major complications (cardiac arrest, extracorporeal membrane oxygenation, arrhythmia requiring intervention, stroke, renal replacement therapy, infection, and reoperation/reintervention).
Results:
We analyzed 1764 surgical CICU admissions. Prolonged LOS was 7 days or longer. Eighteen patients (1.0%) died, of whom 9 (0.5%) died before the LOS cutoff and were excluded from analysis. Of 1755 CICU admissions, 8.8% (n = 156) had prolonged LOS, and 23.3% (n = 413) had 1 or more major complications. Several variables, including The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery 4/5 operation, 3 or more previous sternotomies, and preoperative renal dysfunction/dialysis were independent risk factors for both prolonged LOS and major complications (P < .05). Preoperative ventilation was associated with increased odds of prolonged LOS and preoperative arrhythmia with major complications.
Conclusions:
This analysis of postoperative ACHD care in pediatric CICUs found high complexity operations, 3 or more previous sternotomies, preoperative arrhythmias, renal dysfunction, and respiratory failure are associated with prolonged LOS and/or major complications. Future quality improvement initiatives focused on preoperative optimization and implementation of adult-specific perioperative protocols may mitigate morbidity in these patients undergoing cardiac surgical procedures at children's hospitals.
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