Postoperative complications and association with outcomes in pediatric cardiac surgery

Hemant S Agarwal, Karen B Wolfram, Benjamin R Saville, Brian S Donahue, David P Bichell
Journal of Thoracic and Cardiovascular Surgery 2014, 148 (2): 609-16.e1

OBJECTIVE: Our primary aim was to study postoperative complications in pediatric cardiac surgery patients and their association with cardiopulmonary bypass (CPB) use. The secondary aim was to evaluate the association of postoperative complications with established outcome measures.

METHODS: A single-institution retrospective observational study was undertaken of consecutive pediatric cardiac surgery patients during a 1-year period. Five cardiac and 15 extracardiac complications were studied. CPB use, CPB parameters, demographics, and Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) levels were evaluated as risk factors for complications. Outcomes, including mechanical ventilation duration, pediatric cardiac intensive care unit stay, hospital stay, and mortality were studied.

RESULTS: A total of 325 patients were studied: 271 with CPB and 54 without CPB. Of the 325 patients, 141 (43%) had ≥1 complication (95% confidence interval, 38%-49%). Of the 325 patients, 82 (25%) developed cardiac and 120 (37%) developed extracardiac complications. The evidence from logistic regression analysis was insufficient to suggest a relationship between CPB support and the incidence of cardiac or extracardiac complications after adjusting for age, gender, previous sternotomy, and RACHS-1 levels. For patients receiving CPB, longer CPB times, higher RACHS-1 levels, and a lower temperature with CPB were associated with a greater number of cardiac complications (P < .01). Longer CPB times and higher RACHS-1 levels were associated with a greater number of extracardiac complications (P = .006). Postoperative complications were significantly associated with an increased mechanical ventilation duration, pediatric cardiac intensive care unit stay, and hospital stay and mortality (P < .01).

CONCLUSIONS: Postoperative complications occurred in 43% of pediatric cardiac surgeries performed both with and without CPB. The complications were associated with longer mechanical ventilation and pediatric cardiac intensive care unit and hospital stays, and increased mortality.

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