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Exploring Noncardiac Surgical Needs From Infancy to Adulthood in Patients With Congenital Heart Disease
A Rebecca L Hamilton1, Kirsten C Odegard2, Koichi Yuki2
1Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anaesthesia, Harvard Medical School, Boston, MA; Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden.
Insights
Patients with congenital heart disease (CHD) require increasing noncardiac surgery throughout life. Needs shift from ear, nose, and throat procedures in childhood to orthopedic and dental surgeries in adolescence.
Area of Science:
- Pediatric Cardiology
- Surgical Outcomes
- Congenital Heart Disease Management
Background:
- Rising life expectancy for congenital heart disease (CHD) patients leads to increased noncardiac surgical needs in pediatric and adolescent populations.
- Understanding the evolving surgical landscape for CHD patients is crucial for optimizing perioperative care.
Purpose of the Study:
- To map the spectrum of noncardiac surgical requirements across the lifespan of patients with CHD.
- To analyze trends in noncardiac surgical needs and procedures in children and adolescents with CHD over time.
Main Methods:
- Retrospective review of 3,011 noncardiac surgical procedures performed on patients with CHD between 2008 and 2014.
- Data collected included patient demographics, CHD diagnosis, surgical procedures, and clinical parameters like cardiac function.
- Patients were grouped by cardiac diagnosis for comparative analysis.
Main Results:
- The most frequent CHD diagnoses were patent ductus arteriosus, ventricular septal defects, and patent foramen ovale.
- Ear, nose, and throat (20%), general surgery (14%), and radiology (11%) were the most common procedures.
- Intraoperative events occurred in 16.2% of cases, with higher rates in single-ventricle physiology patients (30.7%).
Conclusions:
- Noncardiac surgical burden is higher in younger age groups.
- Surgical needs evolve, with ear, nose, and throat and general surgery common in young children, and orthopedic and dental procedures increasing in adolescence.
Objectives:
As life expectancy for patients born with congenital heart disease (CHD) continues to rise, these patients will present increasingly for noncardiac surgery during childhood and adolescence. This study aimed to map the lifespan of noncardiac surgical needs among patients with CHD and explore how these needs may change over time.
Design:
All patients with CHD presenting for noncardiac surgery between 2008 and 2014 were selected for review.
Setting:
The study was conducted at a single urban academic tertiary pediatric hospital.
Participants:
All patients with CHD presenting for noncardiac surgery during the study period were included and grouped by cardiac diagnosis.
Interventions:
Descriptive analysis included patient demographics, CHD diagnosis, procedures performed, and clinical data, including baseline saturation and underlying cardiac function.
Measurements And Main Results:
A total of 3,011 noncardiac surgical procedures were performed on patients with CHD during the study period. The most common CHD diagnoses were patent ductus arteriosus (27.6%), ventricular septal defects (24.7%), and patent foramen ovale (24.3%). The median age was 4 years, 87% of all the patients were ≤10 years, and 41% had associated syndromes. Of the patients, 76% underwent a preoperative echocardiogram, and 10% had depressed cardiac function at the time of surgery. The most common procedures performed were ear, nose, and throat (20%), general surgery (14%), and radiology (11%). Intraoperative events were reported in 488 out of 3,010 encounters (16.2%), with the highest rates reported in patients with single-ventricle physiology (55/179; 30.7%).
Conclusions:
These findings suggested a greater burden of noncardiac surgery in lower age groups, with ear, nose, and throat and general surgery most common in young children and orthopedic and dental procedures increasing in adolescence.
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