Dan M Dorobantu1, Deborah Ridout2, Katherine L Brown3, Warren Rodrigues3, Mansour T A Sharabiani4, Christina Pagel5, David Anderson6, Paul Wellman6, Andrew McLean7, Jane Cassidy8, David J Barron9, Victor T Tsang3, Serban C Stoica10. 1. Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom. 2. Population, Policy, and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom. 3. Cardiac and Critical Care Division, Great Ormond Street Hospital, London, United Kingdom. 4. Department of Primary Care & Public Health, School of Public Health, Imperial College of London, London, United Kingdom. 5. Clinical Operational Research Unit, University College London, London, United Kingdom. 6. Departments of Paediatric Cardiology, Intensive Care, and Cardiac Surgery, Evelina London Children's Hospital, London, United Kingdom. 7. Department of Paediatric Cardiac Surgery, Royal Hospital for Children Glasgow, Glasgow, United Kingdom. 8. Department of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom. 9. Division of Cardiovascular Surgery, Toronto Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom. 10. Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom. Electronic address: Serban.Stoica@uhbristol.nhs.uk.
Abstract
OBJECTIVE: Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. METHODS: Morbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uRE patients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. RESULTS: A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). CONCLUSIONS: uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.
OBJECTIVE: Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. METHODS: Morbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uREpatients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. RESULTS: A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). CONCLUSIONS:uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.
Authors: Monique M Gardner; Garrett Keim; Jill Hsia; Anh D Mai; J William Gaynor; Andrew C Glatz; Nadir Yehya Journal: J Am Heart Assoc Date: 2022-06-14 Impact factor: 6.106
Authors: Timothy E Nissen; Isabella Zaniletti; R Thomas Collins; Lawrence E Greiten; Parthak Prodhan; Paul M Seib; Elijah H Bolin Journal: Pediatr Cardiol Date: 2021-07-30 Impact factor: 1.655