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Comparative Study
. 2019 Oct;158(4):1185-1196.e7.
doi: 10.1016/j.jtcvs.2019.03.139. Epub 2019 Jun 12.

Incidence and risk factors for important early morbidities associated with pediatric cardiac surgery in a UK population

Katherine L Brown  1 , Deborah Ridout  2 , Christina Pagel  3 , Jo Wray  4 , David Anderson  5 , David J Barron  6 , Jane Cassidy  6 , Peter J Davis  7 , Warren Rodrigues  8 , Serban Stoica  7 , Shane Tibby  5 , Martin Utley  3 , Victor T Tsang  4
Affiliations
Free article
Comparative Study

Incidence and risk factors for important early morbidities associated with pediatric cardiac surgery in a UK population

Katherine L Brown et al. J Thorac Cardiovasc Surg. 2019 Oct.
Free article

Abstract

Objective: Given excellent 30-day survival for pediatric cardiac surgery, other outcome measures are important. We aimed to study important early postoperative morbidities selected by stakeholders following a rigorous and evidenced-based process, with a view to identifying potential risk factors.

Methods: The incidence of selected morbidities was prospectively measured for 3090 consecutive pediatric cardiac surgical admissions in 5 UK centers between October 2015 and June 2017. The relationship between the candidate risk factors and the incidence of morbidities was explored using multiple regressions. Patient survival, a secondary outcome, was checked at 6 months.

Results: A total of 675 (21.8%) procedure episodes led to at least 1 of the following: acute neurologic event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotizing enterocolitis, surgical infection, or prolonged pleural effusion. The highest adjusted odds ratio of morbidity was in neonates compared with children, 5.26 (95% confidence interval, 3.90-7.06), and complex heart diseases (eg, hypoplastic left heart), 2.14 (95% confidence interval, 1.41-3.24) compared with low complexity (eg, atrial septal defect, P < .001 for all). Patients with any selected morbidity had a 6-month survival of 88.2% (95% confidence interval, 85.4-90.6) compared with 99.3% (95% confidence interval, 98.9-99.6) with no defined morbidity (P < .001).

Conclusions: Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become a focus for audit and quality improvement. Our results have been used to initiate UK-based audit for 5 of these 9 morbidities, co-develop software for local monitoring of these morbidities, and parent information about these morbidities.

Keywords: cardiac surgery; complications; morbidity; outcome; pediatrics.

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Comment in

  • Commentary: It takes a village.
    Hancock Friesen CL. Hancock Friesen CL. J Thorac Cardiovasc Surg. 2019 Oct;158(4):1197-1198. doi: 10.1016/j.jtcvs.2019.04.033. Epub 2019 Apr 24. J Thorac Cardiovasc Surg. 2019. PMID: 31103206 No abstract available.
  • Discussion.
    [No authors listed] [No authors listed] J Thorac Cardiovasc Surg. 2019 Oct;158(4):1195-1196. doi: 10.1016/j.jtcvs.2019.03.141. Epub 2019 Jul 26. J Thorac Cardiovasc Surg. 2019. PMID: 31353099 No abstract available.

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