School of Medicine, Mercer University, Macon, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Cardiol Young. 2021 Apr;31(4):673-681. doi: 10.1017/S1047951120004552. Epub 2021 Jan 7.
Feeding difficulty is a known complication of congenital heart surgery. Despite this, there is a relative sparsity in the available data regarding risk factors, incidence, associated symptoms, and outcomes.
In this retrospective chart review, patients aged 0-18 years who underwent congenital heart surgery at a single institution between January and December, 2017 were reviewed. Patients with feeding difficulties before surgery, multiple surgeries, and potentially abnormal recurrent laryngeal nerve anatomy were excluded. Data collected included patient demographics, feeding outcomes, post-operative symptoms, flexible nasolaryngoscopy findings, and rates of readmission within a 1-year follow-up period. Multivariable regression analyses were performed to evaluate the risk of an alternative feeding plan at discharge and length of stay.
Three-hundred and twenty-six patients met the inclusion criteria for this study. Seventy-two (22.09%) were discharged with a feeding tube and 70 (97.22%) of this subgroup were younger than 12 months at the time of surgery. Variables that increased the risk of being discharged with a feeding tube included patient age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score, procedure group, aspiration, and reflux. Speech-language pathology was the most frequently utilised consulting service for patients discharged with feeding tubes (90.28%) while other services were not frequently consulted. The median length of stay was increased from 4 to 10 days for patients who required an enteral feeding tube at discharge.
Multidisciplinary management protocol and interventions should be developed and standardised to improve feeding outcomes following congenital heart surgery.
喂养困难是先天性心脏病手术后已知的并发症。尽管如此，关于其危险因素、发病率、相关症状和结局的可用数据相对较少。
在这项回顾性图表研究中，研究了 2017 年 1 月至 12 月期间在一家机构接受先天性心脏病手术的 0-18 岁患者。排除术前有喂养困难、多次手术和可能存在异常喉返神经解剖结构的患者。收集的数据包括患者人口统计学资料、喂养结果、术后症状、软性鼻咽喉镜检查结果以及在 1 年随访期内的再入院率。采用多变量回归分析评估出院时替代喂养计划和住院时间的风险。
本研究共纳入 326 名患者。72 名（22.09%）患者出院时带有喂养管，其中 70 名（97.22%）患者在手术时年龄小于 12 个月。增加出院时带喂养管风险的变量包括患者年龄、胸外科医师协会-欧洲心血管外科学会评分、手术组、吸入和反流。言语病理学是为带喂养管出院的患者提供的最常用咨询服务（90.28%），而其他服务则不常被咨询。对于需要在出院时进行肠内喂养的患者，中位住院时间从 4 天增加到 10 天。
应制定和标准化多学科管理方案和干预措施，以改善先天性心脏病手术后的喂养结果。
