Incidence and risk factors for important early morbidities associated with pediatric cardiac surgery in a UK population.
Adolescent
Age Factors
Cardiac Surgical Procedures
/ adverse effects
Child
Child, Preschool
Female
Heart Diseases
/ diagnosis
Humans
Incidence
Infant
Infant, Newborn
Male
Medical Audit
Multimorbidity
Postoperative Complications
/ diagnosis
Prospective Studies
Quality Indicators, Health Care
Retreatment
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United Kingdom
/ epidemiology
cardiac surgery
complications
morbidity
outcome
pediatrics
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
15
11
2018
revised:
20
03
2019
accepted:
22
03
2019
pubmed:
30
7
2019
medline:
3
3
2020
entrez:
30
7
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 31353100
pii: S0022-5223(19)31166-3
doi: 10.1016/j.jtcvs.2019.03.139
pii:
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Webcast
Langues
eng
Sous-ensembles de citation
IM
Pagination
1185-1196.e7Subventions
Organisme : Department of Health
ID : 12/5005/06
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.