Refractory Chylothorax: Descriptive Analysis and Predictive Model in Children with Postoperative Chylothorax

Area of Science:

• Pediatric Cardiac Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Chylothorax is a serious complication following pediatric cardiac surgery, associated with increased morbidity and mortality.
• Clinical outcomes comparing prolonged versus prompt resolution of chylothorax remain underexplored.
• Understanding risk factors for prolonged chylothorax is crucial for optimizing patient management.

Purpose of the Study:

• To describe clinical outcomes of prolonged chylothorax (long chylothorax, LC) versus prompt resolution (short chylothorax, SC) in pediatric cardiac surgery patients.
• To identify patient characteristics and clinical events associated with LC.
• To evaluate chest tube output on postoperative day 7 as a predictor for LC.

Main Methods:

• Retrospective cohort study across eight US pediatric cardiac ICUs.
• Included patients <18 years old treated for chylothorax within 30 days of cardiac surgery (excluding Fontan).
• Defined LC as chest tube duration ≥14 days; SC as <14 days. Used logistic regression for analysis.

Main Results:

• 134 patients had chylothorax; 51 (38%) were LC. LC proportion increased with surgical complexity.
• LC patients had later diagnosis, longer mechanical ventilation, and longer ICU/hospital stays.
• High chest tube output (>20 ml/kg) on POD 7 predicted LC (aOR 7.3); sepsis/CLABSI (aOR 8.8) and open sternum (aOR 3.3) were associated with LC.

Conclusions:

• Long chylothorax is associated with increased resource utilization and morbidity in pediatric cardiac surgery patients.
• Chest tube output on postoperative day 7 may predict LC, enabling earlier identification of at-risk patients.
• Tailored treatment strategies for LC may improve outcomes in this vulnerable population.