An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study

Abstract

Objective: The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.

Methods: This propensity score-matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.

Results: Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, P = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, P = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.

Conclusions: This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.

Keywords: acute kidney injury; fluid overload; neonatal cardiac surgery; peritoneal catheter; peritoneal dialysis.

Neonates with PCs placed during cardiac surgery had better renal outcomes.

Figure 1

Kaplan–Meier curve analysis demonstrating time to first successful extubation attempt comparing the propensity-matched cohorts of patients with intraoperative placement and use of a PC (OR-PC), and those without intraoperative peritoneal catheter placement (No-PC). Time to extubation was not different among cohorts as assessed using log-rank testing.

Figure E1

The incidence of PC placement varied by center. Six centers did not place an intraoperative catheter in any neonates, and 6 centers placed a catheter in more than half of studied neonates.

Figure E2

This balance plot demonstrates the postmatch balance of covariates by absolute standardized difference, with the difference less than 0.2 indicating small or negligible imbalance between groups for the propensity score match of the primary comparison (use of intraoperative placed PC vs no PC). A caliper width of 0.10 (solid line) was used to choose at most 2 controls for each case. Dashed line demonstrates a caliper width of 0.05. Cardsurgaged = age at surgery; Surgwtkg = weight at surgery; Underweight0/1 = underweight at time of surgery; ChromSyndYN0/1 = presence or absence of a chromosomal syndrome; ExtraCardAnomYN0/1 = presence or absence of an extracardiac anomaly; PreOpVentYN0/1 = presence or absence of preoperative mechanical ventilation; SCrBsLn = baseline serum creatinine; PGEyn0/1 = presence or absence of preoperative prostaglandin infusion; STATcat3/4/5 = Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STAT) category; SingleVyn0/1 = single ventricle status (y/n); MUFyn0/1 = use of modified ultrafiltration; CPBtm = cardiopulmonary bypass time in minutes; XclampTm = crossclamp time in minutes; DHCATm = deep hypothermic circulatory arrest time in minutes; PostOpLactVal = postoperative lactate value.