Miller Rebecca, Tumin Dmitry, Tobias Joseph D, McKee Christopher
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
J Surg Res. 2018 Dec;232:298-307. doi: 10.1016/j.jss.2018.06.050. Epub 2018 Jul 14.
As management of congenital heart disease (CHD) improves, children with CHD increasingly present for noncardiac surgery. Prior studies report conflicting results on the association between CHD and adverse outcomes in noncardiac surgery. Studies reporting no such association predominantly analyze older children and adolescents. We evaluated whether the association between CHD and adverse surgical outcomes was attenuated by increased age.
Patients aged 0-17 y, undergoing elective noncardiac surgery, were identified in the National Surgical Quality Improvement Program-Pediatric registry. CHD status was classified as none, minor, major, or severe. Multivariable logistic regression evaluated the association of CHD status with the occurrence of any postoperative complication for groups defined by quintiles of patient age (<1, 1-3, 4-8, 9-13, and 14-17 y). Specific complications included cardiac arrest, reintubation, infection, renal failure, neurological complication, thromboembolic complication, reoperation, 30-d unplanned revisit, 30-d prolonged hospital stay, and mortality.
The analysis included 131,164 children, of whom 6420 had minor CHD, 3825 had major CHD, and 963 had severe CHD. The overall rate of complications was 9%. In multivariable analysis, children <1 y old had greater risk of postoperative complications if they had minor (odds ratio [OR] = 1.97; 95% confidence interval [CI]: 1.70, 2.20; P < 0.001), major (OR = 2.58; 95% CI: 2.28, 2.91; P < 0.001), or severe CHD (OR = 4.37; 95% CI: 3.45, 5.54; P < 0.001). In older age groups, however, the presence of CHD was not independently associated with postoperative complications.
In pediatric noncardiac surgery, an independent association of CHD with postoperative complications was only evident among children <1 y old.
随着先天性心脏病（CHD）管理水平的提高，患有CHD的儿童越来越多地接受非心脏手术。先前的研究报告了CHD与非心脏手术不良结局之间的关联存在相互矛盾的结果。报告无此类关联的研究主要分析年龄较大的儿童和青少年。我们评估了CHD与不良手术结局之间的关联是否会因年龄增长而减弱。
在国家外科质量改进计划 - 儿科登记处中识别出年龄在0至17岁之间接受择期非心脏手术的患者。CHD状态分为无、轻度、重度或极重度。多变量逻辑回归评估了CHD状态与按患者年龄五分位数（<1岁、1至3岁、4至8岁、9至13岁和14至17岁）定义的组中任何术后并发症发生情况之间的关联。具体并发症包括心脏骤停、再次插管、感染、肾衰竭、神经并发症、血栓栓塞并发症、再次手术、30天内非计划复诊、30天内延长住院时间和死亡。
分析纳入了131,164名儿童，其中6420名患有轻度CHD，3825名患有重度CHD，963名患有极重度CHD。总体并发症发生率为9%。在多变量分析中，<1岁的儿童若患有轻度（比值比[OR]=1.97；95%置信区间[CI]：1.70，2.20；P<0.001）、重度（OR=2.58；95%CI：2.28，2.91；P<0.001）或极重度CHD（OR=4.37；95%CI：3.45，5.54；P<0.001），术后并发症风险更高。然而，在年龄较大的组中，CHD的存在与术后并发症并无独立关联。
在儿科非心脏手术中，CHD与术后并发症的独立关联仅在<1岁的儿童中明显。
