Preoperative logGAR Predicts Postoperative Complications in Pediatric Cardiac Surgery: A Retrospective Cohort Study

Anesthesia-related postoperative complications, including prolonged mechanical ventilation, reintubation, and extended intensive care unit stay, remain significant concerns after congenital heart disease (CHD) surgery in children. This study was designed to evaluate whether the preoperative gamma-glutamyl transferase-to-albumin ratio (logGAR), which reflects oxidative stress, inflammation, and nutritional status, can predict anesthesia-related complications in pediatric CHD patients.

Retrospective cohort study.

Single-center, pediatric cardiac surgery unit.

A total of 942 pediatric patients who underwent cardiopulmonary bypass surgery for CHD from 2018 to 2024.

Preoperative logGAR was calculated. No specific interventions were applied for the purpose of this study.

The primary outcomes included mechanical ventilation ≥72 hours, reintubation within 48 hours, intensive care unit length of stay above the 90th percentile, or mortality. Among 942 patients, 164 (17.4%) developed complications. logGAR was significantly higher in the complication group (median -0.97 v -1.32, p < 0.001). Each unit increase in logGAR was associated with a greater risk of complications (adjusted odds ratio: 2.41, 95% confidence interval: 1.49-3.95). A nonlinear relationship was observed, with the strongest association between -1.62 and 0.467. Subgroup analyses showed stronger effects in nonanemic patients and those with lower surgical risk.

Preoperative logGAR is associated with anesthesia-related complications after pediatric CHD surgery. Incorporating logGAR into preanesthetic assessments may improve perioperative risk stratification.