Risk factors and early outcomes associated with prolonged pleural effusion/chylothorax after paediatric cardiac
Dan M Dorobantu1,2, Peter Davis2, Katherine Brown3
1Children's Health and Exercise Research Center, University of Exeter, Exeter, UK.
Insights
Prolonged pleural effusion/chylothorax (PPE/C) after pediatric cardiac surgery increases mortality, especially with other complications. While PPE/C adds hospital days with single morbidities, it does not significantly lengthen stays in complex cases.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Complications
- Postoperative Morbidities
Background:
- Prolonged pleural effusion/chylothorax (PPE/C) is an understudied complication of pediatric cardiac surgery.
- Its incidence, risk factors, and impact on outcomes require further investigation.
Purpose of the Study:
- To determine the incidence and risk factors of PPE/C following pediatric cardiac surgery.
- To evaluate the impact of PPE/C on mortality and hospital length of stay (HLoS).
Main Methods:
- Prospective, multicenter data collection from 5 UK centers (2015-2017).
- Included 3090 procedures in pediatric cardiac surgery patients.
- Analyzed 9 postoperative morbidities, including PPE/C, and their association with outcomes.
Main Results:
- The incidence of PPE/C was 6.5% (202 cases), occurring at a median of 6 days postoperatively.
- PPE/C was associated with increased mortality only when combined with at least two other morbidities.
- PPE/C increased HLoS by 8 days on average, with a greater relative impact in isolated cases.
Conclusions:
- PPE/C addition increases mortality, particularly in multimorbidity scenarios.
- PPE/C significantly increases HLoS in single morbidity cases but not in multimorbidity.
- Emphasizes the importance of preventing, detecting, and managing PPE/C in complex pediatric cardiac surgery.
Objectives:
Prolonged pleural effusion/chylothorax (PPE/C) is a less investigated complication following paediatric cardiac surgery, and its true incidence, risk factors and impact on postoperative outcomes are not well described. We aim to address these gaps in knowledge using data from a prospective, multicentre study.
Methods:
Data on 9 post-operative morbidities (unplanned reinterventions, extracorporeal life support, necrotising enterocolitis, PPE/C, renal replacement therapy, major adverse events, acute neurological events, feeding issues and postsurgical infection) were prospectively collected at 5 UK centres between 2015 and 2017, following paediatric cardiac surgery. Incidence of PPE/C, associations with procedure types, and risk factors were described. Mortality (30-day and 6-month) and hospital length of stay (HLoS) were compared between those with isolated PPE/C, single non-PPE/C morbidity, no morbidity, multimorbidity PPE/C and non-PPE/C multimorbidity.
Results:
A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 202 PPE/C (incidence of 6.5%), occurring at a median of 6 days postoperatively (interquartile range: 3-10). PPE/C was associated with excess early mortality only when complicating scenarios where at least 2 other post-operative morbidities occurred. On average PPE/C is associated with 8 more HLoS days, but the relative impact is greatest when comparing isolated PPE/C with no morbidity (P < 0.001), whereas in multimorbidity scenarios, PPE/C does not significantly contribute to an increase of HLoS.
Conclusions:
Addition of PPE/C increases mortality but not HLoS in multimorbidity and HLoS only in single morbidity scenarios. This reinforces the important role of prevention, early detection and management of PPE/C in complex situations.
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