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Risk factors of gastrointestinal bleeding after cardiopulmonary bypass in children: a retrospective study
Zheng-Qing Li1, Wei Zhang1, Zheng Guo1
1Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Gastrointestinal bleeding is a risk for children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Neonates face the highest risk, with factors like young age and complex surgery increasing vulnerability.
Area of Science:
- Pediatric Cardiology
- Surgical Complications
- Gastrointestinal Health
Background:
- The gastrointestinal system is susceptible to bleeding during cardiopulmonary bypass (CPB) in pediatric cardiac surgery.
- Understanding the incidence and risk factors for GI bleeding in this population is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of postoperative gastrointestinal (GI) bleeding in children undergoing cardiac surgery with CPB.
- To identify significant risk factors associated with GI bleeding in pediatric patients post-CPB.
Main Methods:
- A retrospective study analyzed data from 21,893 pediatric patients (<18 years) who underwent cardiac surgery with CPB between 2013 and 2019.
- The study evaluated the incidence of GI bleeding and associated risk factors using multivariate logistic regression.
Main Results:
- The overall incidence of GI bleeding was 1.9% (410/21,893), with neonates having the highest incidence (22.6%).
- Patients with GI bleeding experienced longer hospital stays and higher mortality rates.
- Independent risk factors for GI bleeding included young age, low weight, complicated surgery, prolonged operation time, ECMO use, low cardiac output syndrome (LCOS), hepatic injury, elevated lactate levels, and low platelet counts.
Conclusions:
- Young age, low weight, complex surgical procedures, extended operation times, and specific complications like ECMO use and LCOS are significant risk factors for GI bleeding post-CPB.
- Proactive monitoring and management strategies targeting these risk factors are essential for mitigating GI bleeding in pediatric cardiac surgery patients.
Background:
During cardiac surgery that involved cardiopulmonary bypass (CPB) procedure, gastrointestinal (GI) system was known to be vulnerable to complications such as GI bleeding. Our study aimed to determine the incidence and risk factors associated with GI bleeding in children who received CPB as part of cardiac surgery.
Methods:
This retrospective study enrolled patients aged <18 years who underwent cardiac surgery with CPB from 2013 to 2019 at Shanghai Children's Medical Center. The primary outcome was the incidence of postoperative GI bleeding in children, and the associated risk factors with postoperative GI bleeding episodes were evaluated.
Results:
A total of 21,893 children who underwent cardiac surgery with CPB from 2013 to 2019 were included in this study. For age distribution, 636 (2.9%) were neonates, 10,984 (50.2%) were infants, and 10,273 (46.9%) were children. Among the 410 (1.9%) patients with GI bleeding, 345 (84.2%) survived to hospital discharge. Incidence of GI bleeding in neonates, infants and children were 22.6% (144/636), 2.0% (217/10,984) and 0.5% (49/10,273), respectively. The neonates (22.6%) group was associated with highest risk of GI bleeding. Patients with GI bleeding showed longer length of hospital stays (25.8 ± 15.9 vs. 12.5 ± 8.9, P < 0.001) and higher mortality (15.9% vs. 1.8%, P < 0.001). Multivariate logistic regression analysis showed that age, weight, complicated surgery, operation time, use of extracorporeal membrane oxygenation (ECMO), low cardiac output syndrome (LCOS), hepatic injury, artery lactate level, and postoperative platelet counts were significantly associated with increased risk of GI bleeding in children with congenital heart disease (CHD) pediatric patients that underwent CPB procedure during cardiac surgery.
Conclusion:
The study results suggest that young age, low weight, long operation time, complicated surgery, use of ECMO, LCOS, hepatic injury, high arterial lactate level, and low postoperative platelet counts are independently associated with GI bleeding after CPB in children.
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