Spaeder Michael C, Carson Kathryn A, Vricella Luca A, Alejo Diane E, Holmes Kathryn W
Division of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA.
Pediatr Cardiol. 2011 Aug;32(6):801-6. doi: 10.1007/s00246-011-9985-9. Epub 2011 Apr 11.
To compare postoperative outcomes in children undergoing cardiac surgery during the viral respiratory season and nonviral season at our institution. This was a retrospective cohort study and secondary matched case-control analysis. The setting was an urban academic tertiary-care children's hospital. The study was comprised of all patients <18 years of age who underwent cardiac surgery at Johns Hopkins Hospital from October 2002 through September 2007. Patients were stratified by season of surgery, complexity of cardiac disease, and presence or absence of viral respiratory infection. Measurements included patient characteristics and postoperative outcomes. The primary outcome was postoperative length of stay (LOS). A total of 744 patients were included in the analysis. There was no difference in baseline characteristics or outcomes, specifically, no difference in postoperative LOS, intensive care unit (ICU) LOS, and mortality, among patients by seasons of surgery. Patients with viral respiratory illness were more likely to have longer postoperative LOS (p < 0.01) and ICU LOS (p < 0.01) compared with matched controls. We identified no difference in postoperative outcomes based on season in patients undergoing cardiac surgery. Children with viral respiratory infection have significantly worse outcomes than matched controls, strengthening the call for universal administration of influenza vaccination and palivizumab to appropriate groups. Preoperative testing for respiratory viruses should be considered during the winter months for children undergoing elective cardiac surgery.
比较我院心脏手术患儿在病毒性呼吸道疾病流行季节与非流行季节的术后结局。这是一项回顾性队列研究及二次配对病例对照分析。研究地点为一家城市学术型三级儿童医院。研究对象为2002年10月至2007年9月在约翰霍普金斯医院接受心脏手术的所有18岁以下患者。患者按手术季节、心脏病复杂程度以及是否存在病毒性呼吸道感染进行分层。测量指标包括患者特征及术后结局。主要结局为术后住院时间（LOS）。共有744例患者纳入分析。手术季节不同的患者在基线特征或结局方面无差异，具体而言，术后LOS、重症监护病房（ICU）住院时间及死亡率均无差异。与配对对照组相比，患有病毒性呼吸道疾病的患者术后LOS（p < 0.01）和ICU住院时间（p < 0.01）更长。我们发现接受心脏手术的患者术后结局不存在基于季节的差异。患有病毒性呼吸道感染的儿童结局明显比配对对照组差，这进一步呼吁对合适人群普遍接种流感疫苗和帕利珠单抗。对于择期心脏手术患儿，冬季应考虑进行呼吸道病毒的术前检测。
