Gaies Michael, Pasquali Sara K, Donohue Janet E, Dimick Justin B, Limbach Sarah, Burnham Nancy, Ravishankar Chitra, Ohye Richard G, Gaynor J William, Mascio Christopher E
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan.
Ann Thorac Surg. 2016 Aug;102(2):628-35. doi: 10.1016/j.athoracsur.2016.02.043. Epub 2016 May 4.
Understanding the seminal complications leading to death after pediatric cardiac surgical procedures may provide opportunities to reduce mortality. This study analyzed all deaths at two pediatric cardiac surgical programs and developed a method to identify the seminal complications and modes of death.
Trained nurses abstracted all cases of in-hospital mortality meeting inclusion criteria from each site over 5 years (2008 to 2012). Complication definitions were consistent with those of a multicenter clinical registry. An adjudication committee assigned a seminal complication in each case (the complication initiating the cascade of events leading to death). Seminal complications were grouped into categories to designate "mode of death." The epidemiology of seminal complications and of mode of death was described.
In 191 subjects, low cardiac output syndrome (71% of all subjects), cardiac arrest (52%), and arrhythmia (48%) were the most common complications. The committee assigned low cardiac output syndrome (30%), failure to separate from bypass (16%), and cardiac arrest (12%) most frequently as seminal complications. Seminal complications occurred a median 2 hours (interquartile range [IQR], 0 to 35 hours) postoperatively. Patients experienced a median of seven (IQR, 3 to 12) additional complications before death at a median of 15 days (IQR, 4 to 46). Systemic circulatory failure was the most common mode of death (51%), followed by inadequate pulmonary blood flow (13%) and cardiac arrest (12%).
Seminal complications occurred early postoperatively, and systemic circulatory failure was the most common mode of death. Our classification system is likely scalable for subsequent multicenter analysis to understand cause-specific mortality variation across hospitals and to drive quality improvement.
了解小儿心脏外科手术后导致死亡的主要并发症可能为降低死亡率提供机会。本研究分析了两个小儿心脏外科项目中的所有死亡病例，并开发了一种方法来识别主要并发症和死亡模式。
经过培训的护士提取了5年（2008年至2012年）期间各机构符合纳入标准的所有院内死亡病例。并发症定义与多中心临床登记处的定义一致。一个裁决委员会为每个病例确定一种主要并发症（引发导致死亡的一系列事件的并发症）。主要并发症被归类以指定“死亡模式”。描述了主要并发症和死亡模式的流行病学情况。
在191名受试者中，低心排血量综合征（占所有受试者的71%）、心脏骤停（52%）和心律失常（48%）是最常见的并发症。委员会最常将低心排血量综合征（30%）、体外循环脱机失败（16%）和心脏骤停（12%）确定为主要并发症。主要并发症发生在术后中位时间2小时（四分位间距[IQR]，0至35小时）。患者在死亡前中位经历了7种（IQR，3至12种）额外并发症，中位时间为15天（IQR，4至46天）。全身循环衰竭是最常见的死亡模式（51%），其次是肺血流量不足（13%）和心脏骤停（12%）。
主要并发症发生在术后早期，全身循环衰竭是最常见的死亡模式。我们的分类系统可能适用于后续的多中心分析，以了解不同医院特定病因死亡率的差异，并推动质量改进。
