Setton Matan, He Wei, Benavidez Oscar J
Division of Pediatric-Congenital Cardiology, Department of Pediatric, MassGeneral Hospital for Children, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 510, Boston, MA, 02114, USA.
Pediatr Cardiol. 2019 Jun;40(5):987-993. doi: 10.1007/s00246-019-02103-5. Epub 2019 Apr 11.
The frequency of complications during Adult Congenital Heart Disease (ACHD) surgery admissions and their association to patient outcome is not well known. Our study objectives are to (1) define the frequency of complications during ACHD surgery admissions, (2) identify their risk factors, and (3) explore their association with death and resource use. We identified ACHD surgery admissions ages 18 to 49 during the years 2005-2009 from the Nationwide Inpatient Sample database. Complications were defined according to the Society of Thoracic Surgeons Short List of Complications for congenital heart surgery. We identified 16,841 ACHD surgery admissions, of which 46.9% had at least one complication. Cardiac (19.4%), respiratory (18.2%), infectious (14.1%), and acute kidney injury (6.8%) were the most common. Admissions with a complication had a longer length of stay (10 days vs. 5 days; p < 0.001), increased charges ($139,522 vs. $84,672; p < 0.001), and higher mortality (4.6% vs. 0.9%; p < 0.001). Adjusted risk factors for complications included non-White race (AOR 1.17, p = 0.003), government insurance AOR 1.39, high surgical complexity RACHS-1 category 3 + AOR 1.81, non-elective admission OR 2.18, chronic kidney disease AOR 2.79, chronic liver disease AOR 2.47, and CHF AOR 1.40; all p < 0.001. Complications were independently associated with death AOR 2.49, p < 0.001. Complications occur frequently during ACHD surgery admissions and are associated with increased resource use and are a risk factor for death. Identification of preventable morbidity may improve the outcomes of these complex patients.
成人先天性心脏病（ACHD）手术住院期间并发症的发生率及其与患者预后的关系尚不清楚。我们的研究目标是：（1）确定ACHD手术住院期间并发症的发生率；（2）识别其危险因素；（3）探讨其与死亡和资源利用的关系。我们从全国住院患者样本数据库中确定了2005年至2009年期间年龄在18至49岁的ACHD手术住院患者。并发症根据胸外科医师协会先天性心脏病手术并发症简表进行定义。我们确定了16841例ACHD手术住院患者，其中46.9%至少发生了一种并发症。心脏并发症（19.4%）、呼吸并发症（18.2%）、感染并发症（14.1%）和急性肾损伤（6.8%）最为常见。发生并发症的住院患者住院时间更长（10天对vs比5天；p<0.001），费用增加（139522美元对vs比84672美元；p<0.001），死亡率更高（4.6%对vs比0.9%；p<0.001）。并发症的校正危险因素包括非白人种族（比值比[AOR]1.17，p=0.003）、政府保险（AOR 1.39）、手术复杂性高的RACHS-1 3类及以上（AOR 1.81）、非择期住院（比值比[OR]2.18）、慢性肾病（AOR 2.79）、慢性肝病（AOR 2.47）和心力衰竭（AOR 1.40）；所有p<0.001。并发症与死亡独立相关（AOR 2.49，p<0.001）。ACHD手术住院期间并发症频繁发生，与资源利用增加相关，是死亡的危险因素。识别可预防的发病率可能会改善这些复杂患者的预后。
