Chu David I, Tan Jonathan M, Mattei Peter, Costarino Andrew T, Rossano Joseph W, Tasian Gregory E
Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Anesthesia and Critical Care Medicine, Division of General Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr. 2017 Jun;185:88-93.e3. doi: 10.1016/j.jpeds.2017.02.011. Epub 2017 Mar 3.
To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD).
Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD.
Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13).
Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.
确定先天性心脏病（CHD）患儿腹腔镜手术后发病和死亡的风险。
采用2013 - 2014年国家外科质量改进计划 - 儿科进行队列研究，该计划分别于2013年和2014年在56家及64家医院前瞻性收集数据。主要暴露因素为CHD。主要结局为术后总体院内死亡率。次要结局包括30天死亡率和30天发病率（任何非死亡不良事件）。在34543例行腹腔镜手术的儿童中，分别有1349例、1106例和266例患有轻度、重度和极重度CHD。在CHD严重程度的每个分层内进行倾向得分匹配后，比较有CHD和无CHD儿童的发病率和死亡率。
与匹配的对照组相比，极重度CHD患儿的总体死亡率和30天发病率更高（分别为OR 12.31，95%CI 1.59 - 95.01；OR 2.51，95%CI 1.57 - 4.01）。与无CHD儿童相比，重度CHD患儿的总体死亡率和30天发病率也更高（分别为OR 3.46，95%CI 1.49 - 8.06；OR 2.07，95%CI 1.65 - 2.61）。轻度CHD患儿的死亡率结果相似，但与无CHD儿童相比，30天发病率更高（OR 1.71，95%CI 1.37 - 2.13）。
重度或极重度CHD患儿腹腔镜手术后的发病率和死亡率更高。临床医生在医疗决策过程中应考虑这些患儿进行腹腔镜手术时增加的风险。
