Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.
J Am Heart Assoc. 2018 May 12;7(10):e008094. doi: 10.1161/JAHA.117.008094.
Patients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in-hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy.
This is a retrospective cohort study of patients <18 years undergoing heart surgery at our center from January 1, 2013 to January 31, 2015. Demographic, and pre-, intra-, and postoperative clinical and rehabilitation therapy (physical, occupational, speech, feeding therapy, and neurodevelopment intervention) data were collected. Need for rehabilitation therapy in the acute postoperative period, particularly following palliative repair, was the outcome variable in a multivariable logistic regression model to identify independent pre- and intraoperative factors associated with therapy. A total of 586 out of 1415 (41%) subjects received rehabilitation therapy postsurgery. Certain subgroups had increased rehabilitation therapy use such as neonates (80%). On multivariable analysis, palliative repair, prematurity, genetic syndrome, presurgical hospital stay of more than 1 day, and prolonged cardiopulmonary bypass time were independently associated with rehabilitation therapy.
Nearly half of patients who underwent post-congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre- and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision-making for appropriate resource allocation.
患有先天性心脏病的患者在心脏手术后有运动、认知、言语和喂养困难的风险。如果在心脏手术后的急性住院期间应用康复治疗，这种治疗方法可能会改善该人群的功能结局。然而，关于儿童急性心脏手术后治疗需求的信息很少。我们的目标是描述先天性心脏病手术后的康复治疗以及与治疗需求相关的术前/术中因素。
这是一项回顾性队列研究，纳入了 2013 年 1 月 1 日至 2015 年 1 月 31 日在我们中心接受心脏手术的<18 岁患者。收集了人口统计学、术前、术中及术后临床和康复治疗（物理、职业、言语、喂养治疗和神经发育干预）数据。在多变量逻辑回归模型中，将急性术后康复治疗的需求（尤其是姑息性修复术后）作为因变量，以确定与治疗相关的独立术前和术中因素。在 1415 例患者中，共有 586 例（41%）患者在手术后接受了康复治疗。某些亚组患者接受康复治疗的比例较高，例如新生儿（80%）。多变量分析显示，姑息性修复、早产、遗传综合征、术前住院时间超过 1 天以及体外循环时间延长与康复治疗独立相关。
近一半接受先天性心脏病手术后的患者接受了康复治疗。治疗的使用频率和类型因患者特征而异；然而，某些术前和术中因素与康复治疗的需求相关，这可能有助于决策适当的资源分配。
