Shannon M Jones1, Courtney McCracken2, Bahaaldin Alsoufi3, William T Mahle4, Matthew E Oster4. 1. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Electronic address: joness@kidsheart.com. 2. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 3. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. 4. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Abstract
BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children. METHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count < 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category. RESULTS: Overall mortality was 2.8%, median LOS was 6 days, and 7.6% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support. CONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.
BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children. METHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count < 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category. RESULTS: Overall mortality was 2.8%, median LOS was 6 days, and 7.6% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support. CONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.
Authors: Shu Peng; Liu Huang; Bo Zhao; Shuchang Zhou; Irene Braithwaite; Ni Zhang; Xiangning Fu Journal: J Thorac Cardiovasc Surg Date: 2020-04-10 Impact factor: 5.209
Authors: Lucas Hoyos Mejía; Alejandra Romero Román; Mariana Gil Barturen; Maria Del Mar Córdoba Pelaez; José Luis Campo-Cañaveral de la Cruz; José Manuel Naranjo; Silvana Crolwey Carrasco; Shin Tanaka; Alvaro Sánchez Calle; Andrés Varela de Ugarte; David Gómez de Antonio Journal: Eur J Cardiothorac Surg Date: 2020-11-01 Impact factor: 4.191