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Health-Related Quality of Life in Children 4-5 Years After Open Heart Surgery in Early Infancy
Luiz Almeida1,2, Sunita Vohra2, Jeffrey A Johnson3
1Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada.
Insights
Children undergoing complex cardiac surgery in early infancy have lower health-related quality of life (HRQL) than healthy peers. Their HRQL is comparable to children with other chronic illnesses, highlighting long-term impacts.
Area of Science:
- Pediatric Cardiology
- Health Outcomes Research
- Quality of Life Studies
Background:
- Health-related quality of life (HRQL) is a critical outcome measure in pediatric care.
- Assessing HRQL in infants undergoing complex cardiac surgery (CCS) is essential for understanding long-term well-being.
- Early infancy (≤6 weeks) is a vulnerable period for major cardiac interventions.
Purpose of the Study:
- To evaluate the health-related quality of life (HRQL) in children who had complex cardiac surgery (CCS) at ≤6 weeks of age.
- To compare the HRQL of these children with healthy peers and those with chronic illnesses at 4-5 years of follow-up.
- To identify predictors associated with lower HRQL scores in this pediatric population.
Main Methods:
- A prospective inception cohort study followed children undergoing CCS at ≤6 weeks of age.
- Parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) at 4-5 year follow-up.
- Statistical analyses, including linear regressions, were used to compare scores and identify risk factors.
Main Results:
- Of 593 survivors, 453 (76.4%) completed the HRQL assessment.
- The mean PedsQL total score (79.5) was significantly lower than in healthy children (87.4) but similar to chronically ill children (76.0).
- Single ventricle palliation, chromosomal abnormality, ECMO, and noncardiac hospitalizations were independent risk factors for lower PedsQL scores.
Conclusions:
- Children who underwent complex cardiac surgery (CCS) in early infancy exhibit diminished health-related quality of life (HRQL).
- Their HRQL outcomes are comparable to those of children with other chronic illnesses.
- Specific surgical types and medical complications significantly impact long-term HRQL in these children.
Background:
Health-related quality of life (HRQL) is an important outcome measure in pediatrics. We aimed to determine HRQL of children who underwent complex cardiac surgery at age ≤6 weeks with follow-up at age 4-5 years.
Methods:
We prospectively followed an inception cohort of children after complex cardiac surgery (CCS) performed at age ≤6 weeks at Stollery Children's Hospital between 2000 and 2014. At the 4- to 5-year follow-up visit, parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL). Scores were compared with a normative healthy population and with children with chronic illness of a similar age. Predictors of PedsQL scores were determined using univariate and multiple linear regressions, with P ≤ 0.05 considered statistically significant.
Results:
Of 712 children who underwent CCS at ≤6 weeks of life, 119 (16.7%) died and 140 did not complete the HRQL questionnaire (for multiple reasons), leaving 453 of 593 (76.4%) survivors included. At 4- to 5-year follow-up, the PedsQL total score (mean: 79.5, standard deviation [SD]: 16.3) was significantly lower than that in the healthy normative population (mean: 87.4, SD: 12.7) and similar to that in children with chronic illness (mean: 76.0, SD: 19.3). Patients after single ventricle palliation had a significantly lower PedsQL total score (mean: 72.8, SD: 17.1) than that in patients after biventricular repairs (mean: 82.4, SD: 15.1). Independent risk factors for lower PedsQL scores consistently included single ventricle palliation, chromosomal abnormality, extracorporeal membrane oxygenation, and the number of noncardiac hospitalizations.
Conclusion:
The HRQL of children who underwent CCS in early infancy is lower than that of healthy children but similar to that of children with other chronic illnesses.
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