Makoto Mori1, Courtney McCracken2, Kevin Maher2, Brian Kogon1, William Mahle2, Kirk Kanter1, Bahaaldin Alsoufi3. 1. Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. 2. Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. 3. Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. Electronic address: balsoufi@hotmail.com.
Abstract
OBJECTIVE: After neonatal cardiac surgery, a number of patients need a prolonged stay in the intensive care unit (ICU). Those patients require tremendous resources and strain the capacity of cardiac units. To date, little knowledge of early and late survival for this challenging population exists. METHODS: From 2002 to 2012, 108 neonates required a postoperative ICU stay >30 days. Multivariable regression analyses examined factors associated with hospital death and late survival. Comparison of late outcomes in hospital survivors was made between those who had prolonged ICU stay (n = 82) and contemporaneous neonates who did not (n = 1329). RESULTS: Hospital mortality occurred in 26 of 108 patients (24%). On multivariable analysis, factors associated with mortality were use of extracorporeal membrane oxygenation (odds ratio, 3.4 [95% confidence interval, 1.3-9.1], P = .014) and renal failure that required dialysis (odds ratio, 3.1 [95% confidence interval, 1.0-10.0], P = .056). Overall survival at 1 and 8 years was 57% and 51%. Comparison of late outcomes for hospital survivors showed that neonates who required prolonged postoperative stay in the ICU had significantly worse 8-year survival (69% vs 92%; P < .001) and that the effect of prolonged stay in the ICU on diminished survival was more pronounced in neonates with 2 ventricles (68% vs 95%, hazard ratio, 8.0 [95% confidence interval, 4.2-15.1], P < .001) than in those with single ventricle (66% vs 81%; hazard ratio, 2.0 [95% confidence interval, 1.1-3.5], P = .021). Overall, 77% of single-ventricle hospital survivors who required prolonged stay in the ICU progressed to Glenn, with 82% of them reaching or qualifying for subsequent Fontan. CONCLUSIONS: Prolonged postoperative stay in the ICU is associated with high hospital and significant postdischarge mortality, mainly during the first year. In neonates with single ventricle, prolonged stay in the ICU was associated with high hospital and interstage mortality and usual progression subsequent to Glenn shunt. In contrast, prolonged stay in the ICU in neonates with 2 ventricles was associated with high hospital mortality and considerable decrease in late survival, suggesting a more pronounced deviation from expected survival in those patients.
OBJECTIVE: After neonatal cardiac surgery, a number of patients need a prolonged stay in the intensive care unit (ICU). Those patients require tremendous resources and strain the capacity of cardiac units. To date, little knowledge of early and late survival for this challenging population exists. METHODS: From 2002 to 2012, 108 neonates required a postoperative ICU stay >30 days. Multivariable regression analyses examined factors associated with hospital death and late survival. Comparison of late outcomes in hospital survivors was made between those who had prolonged ICU stay (n = 82) and contemporaneous neonates who did not (n = 1329). RESULTS: Hospital mortality occurred in 26 of 108 patients (24%). On multivariable analysis, factors associated with mortality were use of extracorporeal membrane oxygenation (odds ratio, 3.4 [95% confidence interval, 1.3-9.1], P = .014) and renal failure that required dialysis (odds ratio, 3.1 [95% confidence interval, 1.0-10.0], P = .056). Overall survival at 1 and 8 years was 57% and 51%. Comparison of late outcomes for hospital survivors showed that neonates who required prolonged postoperative stay in the ICU had significantly worse 8-year survival (69% vs 92%; P < .001) and that the effect of prolonged stay in the ICU on diminished survival was more pronounced in neonates with 2 ventricles (68% vs 95%, hazard ratio, 8.0 [95% confidence interval, 4.2-15.1], P < .001) than in those with single ventricle (66% vs 81%; hazard ratio, 2.0 [95% confidence interval, 1.1-3.5], P = .021). Overall, 77% of single-ventricle hospital survivors who required prolonged stay in the ICU progressed to Glenn, with 82% of them reaching or qualifying for subsequent Fontan. CONCLUSIONS: Prolonged postoperative stay in the ICU is associated with high hospital and significant postdischarge mortality, mainly during the first year. In neonates with single ventricle, prolonged stay in the ICU was associated with high hospital and interstage mortality and usual progression subsequent to Glenn shunt. In contrast, prolonged stay in the ICU in neonates with 2 ventricles was associated with high hospital mortality and considerable decrease in late survival, suggesting a more pronounced deviation from expected survival in those patients.
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