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Pediatric Cardiac Surgery Complications and the Risk Factors: A Single-Center Study
Mohammadreza Mirzaaghayan1, Zahra Vahdati2, Hossein Nematian2
1Department of General Surgery, School of Medicine, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Postoperative complications in pediatric heart surgery are linked to longer mechanical ventilation and intensive care unit stays, but not mortality. Understanding these factors aids in improving patient outcomes after cardiac procedures.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Postoperative complications following pediatric cardiac surgery are a significant concern.
- Identifying risk factors is crucial for improving surgical outcomes and patient care.
Purpose of the Study:
- To determine the incidence of postoperative cardiac and noncardiac complications in pediatric cardiac surgery.
- To investigate the association of cardiopulmonary bypass (CPB) use, surgical complexity, and outcomes with these complications.
Main Methods:
- Retrospective cross-sectional study of pediatric patients (0-18 years) undergoing cardiac surgery.
- Analysis of CPB duration, RACHS-1 (Risk-Adjusted Classification for Congenital Heart Surgery) score, mechanical ventilation, and ICU stay.
- Logistic regression to assess risk factors for complications and mortality.
Main Results:
- 26.9% of pediatric cardiac surgeries resulted in at least one complication.
- Increased CPB duration and higher RACHS-1 scores were associated with higher odds of cardiac complications.
- Prolonged mechanical ventilation and longer ICU stays correlated significantly with both cardiac and noncardiac complications.
Conclusions:
- Postoperative complications are prevalent in pediatric cardiac surgery, particularly associated with prolonged ventilation and ICU care.
- While complications are linked to specific surgical factors, they did not show a significant association with mortality in this cohort.
- Further research may focus on mitigating risks associated with CPB and optimizing post-operative care.
Background:
This study aimed to determine postoperative cardiac and noncardiac complications and their association with the use of cardiopulmonary bypass (CPB), surgical outcomes (length of hospital and ICU stays), dependence on mechanical ventilation, and mortality.
Methods:
This retrospective cross-sectional study was conducted on pediatric patients aged 0 to 18 who underwent open or closed cardiac surgery over a 1-year period. The use of CPB support, CPB duration, cardiac surgery complexity according to the risk-adjusted classification for congenital heart surgery (RACHS-1), and demographics were examined as potential risk factors associated with an increased number of postoperative complications. The study was performed at the Children's Medical Center, a teaching hospital affiliated with Tehran University of Medical Sciences in Iran.
Results:
A total of 283 surgeries were included in our study. Seventy-six (26.9%) of the study population experienced at least 1 complication. Our analysis revealed that increased CPB durations were associated with higher odds of cardiac complications, with an odds ratio of 1.02 (P=0.002). Moreover, higher RACHS-1 levels were significantly associated with greater numbers of cardiac and noncardiac complications. Additionally, prolonged mechanical ventilation and open-heart surgery intensive care unit (OH-ICU) stays were significantly associated with cardiac and noncardiac complications. Our logistic regression analysis found no association between demographic and clinical risk factors, the number of complications, and mortality.
Conclusion:
Postoperative complications occurred in 27% of pediatric heart surgeries. Prolonged mechanical ventilation and OH-ICU stays were significantly associated with cardiac and noncardiac complications. However, no significant association was found between postoperative complications and mortality.
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