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Published on: July 18, 2014
Unplanned Return to Cardiac Intensive Care Unit of Children After Congenital Heart Surgery: Incidence, Outcomes, and
Ze-Wei Lin1, Wen-Hao Lin1, Shi-Hao Lin1
1Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou, China. caohua0791@163.com.
Insights
Unplanned returns to the pediatric cardiac intensive care unit (CICU) after congenital heart disease surgery are rare but increase mortality. Key risk factors include chromosomal abnormalities, prolonged ventilation, and cardiopulmonary bypass.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Unplanned returns to the pediatric cardiac intensive care unit (CICU) following congenital heart disease (CHD) surgery are not well understood.
- Characterizing the incidence, outcomes, and risk factors for these returns is crucial for improving patient care.
Purpose of the Study:
- To determine the incidence and outcomes of unplanned returns to the CICU in children after CHD surgery.
- To identify specific risk factors associated with unplanned CICU readmissions.
Main Methods:
- Retrospective analysis of postoperative CHD patients who were initially discharged from the CICU.
- Assessment of demographic, preoperative, intraoperative, and postoperative variables.
- Univariate and multivariate regression analyses to identify risk factors for unplanned returns.
Main Results:
- Of 531 eligible children, 29 (5.5%) experienced unplanned returns to the CICU.
- Common reasons for return included respiratory (41.4%) and cardiac (44.8%) symptoms.
- Unplanned returns were associated with significantly higher mortality (13.8% vs. 0.56%, P < 0.01).
- Multivariate analysis identified chromosomal abnormalities, longer ventilator duration, and prolonged cardiopulmonary bypass as significant risk factors.
Conclusions:
- Unplanned CICU readmission after CHD surgery, though uncommon, is linked to increased mortality.
- Chromosomal abnormalities, extended mechanical ventilation, and prolonged cardiopulmonary bypass are key risk factors.
- Modifying CICU transfer protocols and early postoperative care for high-risk patients may reduce unplanned returns.
Objective:
Factors leading to an unplanned return to the cardiac intensive care unit (CICU) in children after congenital heart disease and their impact on mortality have not been well characterized. We sought to determine the incidence and outcomes of unplanned return to the CICU. A secondary objective was to identify risk factors.
Methods:
Retrospective analysis of the registration data collected by our unit. The study subjects included postoperative patients with congenital heart disease who survived to initial transfer out of the CICU. Patients who unexpectedly returned to the CICU due to an acute change in clinical status were defined as unplanned returns. Demographic, preoperative, intraoperative, and postoperative variables were assessed. Univariate comparisons were performed between the return group and non-return group, and multivariate regression analysis was performed to identify potential risk factors for unplanned return to the CICU.
Results:
Of the 531 children who met the inclusion criteria, 29 were unplanned returns to the CICU. Respiratory symptoms (41.4%) and cardiac symptoms (44.8%) were the most common reasons for returning to the CICU. Patients with unplanned returns had a higher mortality rate (13.8% vs. 0.56%, P < 0.01). In multivariate analysis, unplanned CICU admission was associated with chromosomal abnormalities (P < 0.01), longer ventilator duration (P < 0.01), and more prolonged cardiopulmonary bypass (P < 0.01) was associated with a return to independence.
Conclusions:
Unplanned return to the CICU during the same hospital stay was uncommon but associated with higher mortality. Chromosomal abnormalities, longer ventilator use duration, and prolonged CPB were significant risk factors for the entire cohort. We hope to minimize the impact of unplanned return after congenital heart disease surgery by changing the process of transferring these high-risk postoperative patients out of the CICU and early postoperative care.
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