Katherine L Brown1, Deborah Ridout2, Christina Pagel3, Jo Wray4, David Anderson5, David J Barron6, Jane Cassidy6, Peter J Davis7, Warren Rodrigues8, Serban Stoica7, Shane Tibby5, Martin Utley3, Victor T Tsang4. 1. Cardiac and Critical Care Division, Great Ormond Street Hospital National Health Service Foundation Trust, London, United Kingdom. Electronic address: Katherine.brown@gosh.nhs.uk. 2. Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom. 3. Clinical Operational Research Unit, University College London, London, United Kingdom. 4. Cardiac and Critical Care Division, Great Ormond Street Hospital National Health Service Foundation Trust, London, United Kingdom. 5. Department Paediatric Cardiology and Cardiac Surgery, Evelina London Children's Hospital, London, United Kingdom. 6. Department of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom. 7. Paediatric Intensive Care Unit and Department of Paediatric Cardiac Surgery, Bristol Royal Children's Hospital, Bristol, United Kingdom. 8. Department of Intensive Care and Paediatric Cardiac Surgery, Royal Hospital for Children, Glasgow, Scotland.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Farrukh Javed; Nabil Abdulrahman Aleysae; Abdulmajid Yahya Al-Mahbosh; Amal Ali Zubani; Ali Mohammed Atash; Hanan Bin Salem; Mohamed Abdallah; Omaima Alkhatib; Ashraf Abu-Adas; Maymoona Abdelmouz Hrays; Nawal Ali Alqarni; Alla Felemban; Saad Abdullah Alsaedi; Ahmed Abdullah Jamjoom Journal: J Saudi Heart Assoc Date: 2021-10-15
Authors: Katherine L Brown; Christina Pagel; Deborah Ridout; Jo Wray; David Anderson; David J Barron; Jane Cassidy; Peter Davis; Emma Hudson; Alison Jones; Andrew Mclean; Stephen Morris; Warren Rodrigues; Karen Sheehan; Serban Stoica; Shane M Tibby; Thomas Witter; Victor T Tsang Journal: BMJ Open Date: 2019-09-09 Impact factor: 2.692
Authors: Jo Wray; Deborah Ridout; Alison Jones; Peter Davis; Paul Wellman; Warren Rodrigues; Emma Hudson; Victor Tsang; Christina Pagel; Katherine L Brown Journal: Ann Thorac Surg Date: 2020-11-27 Impact factor: 4.330