What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study.
Adolescent
Age Factors
Cardiac Surgical Procedures
/ adverse effects
Child
Child, Preschool
Female
Heart Diseases
/ diagnosis
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
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
paediatrics
quality of life
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
09 09 2019
09 09 2019
Historique:
entrez:
11
9
2019
pubmed:
11
9
2019
medline:
2
10
2020
Statut:
epublish
Résumé
Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months. The design was a prospective, multicentre, multidisciplinary mixed methods study. The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment. Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy. Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001). Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.
Identifiants
pubmed: 31501104
pii: bmjopen-2018-028533
doi: 10.1136/bmjopen-2018-028533
pmc: PMC6738689
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e028533Subventions
Organisme : Department of Health
ID : 12/5005/06
Pays : United Kingdom
Investigateurs
Martin Utley
(M)
Sheryl Snowball
(S)
Luke Maidment
(L)
Sarah Bohannon
(S)
Liz Smith
(L)
Kate Penny-Thomas
(K)
Joanne Webb
(J)
Sinead Cummins
(S)
John Stickley
(J)
Natasha Khan
(N)
Teresa Dickson
(T)
Ray Samson
(R)
Isobel Mcleod
(I)
Paul Wellman
(P)
Rhian Lakhani
(R)
Kathleen Selway
(K)
Carrie Cherrington
(C)
Andrew Parry
(A)
Rob Tulloh
(R)
Bill Gaynor
(B)
Rodney Franklin
(R)
Lisa Allera
(L)
Kate Bull
(K)
Trevor Ritchens
(T)
Branko Mimic
(B)
Jon Smith
(J)
Lyvonne Tume
(L)
Vibeke Hjortdal
(V)
Michael Vath
(M)
Tom Treasure
(T)
Anne Keatley Clarke
(AK)
Bea Tuten
(B)
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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