Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
J Surg Res. 2021 Mar;259:407-413. doi: 10.1016/j.jss.2020.09.014. Epub 2020 Oct 21.
Infants with congenital heart disease (CHD) may exhibit increased metabolic demands, and many will undergo placement of a gastrostomy to achieve adequate nutritional intake. There is a paucity of data, however, comparing the operative risks and overall complications of gastrostomy placement in cyanotic versus acyanotic infants with CHD. We hypothesized that patients with cyanotic CHD would have a higher rate of gastrostomy-associated complications than infants with acyanotic CHD.
We retrospectively reviewed patients who underwent gastrostomy button placement after cardiac surgery for CHD between 2013 and 2018. Patients were stratified into cyanotic CHD and acyanotic CHD cohorts. Patient data were extracted from the Society of Thoracic Surgeons database and merged with clinical data related to gastrostomy placement and complications from chart review. Unadjusted analyses were used to find covariates associated with cyanotic CHD and acyanotic CHD, using a t-test or Wilcoxon rank-sum test for continuous data, depending on normalcy, and χ or Fisher's exact tests for categorical data depending on the distribution.
There were 257 infants with CHD who underwent gastrostomy placement during the study period, of which 86 had cyanotic CHD. There were no significant differences in baseline weight or preoperative albumin levels between the two groups. Patients with cyanotic CHD had a lower incidence of comorbid syndromes (P = 0.0001), higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores (P < 0.0001), and higher postoperative mortality rate (P = 0.0189). There was a higher rate of granulation tissue formation in patients with acyanotic CHD (48.5% versus 22.1%, P < 0.0001). There were no differences in other gastrostomy button-related complications, including leakage, wound infection, or dislodgement.
Patients with acyanotic CHD demonstrated a higher incidence of granulation tissue. We found no difference in gastrostomy-specific complication rates between the two groups, with the notable exception of granulation tissue formation. Based on this study, the diagnosis of cyanotic CHD does not increase the risk of gastrostomy-related complications.
患有先天性心脏病 (CHD) 的婴儿可能会表现出代谢需求增加，许多婴儿需要进行胃造口术以获得足够的营养摄入。然而，关于紫绀型与非紫绀型 CHD 婴儿胃造口术的手术风险和总体并发症的数据很少。我们假设紫绀型 CHD 患者的胃造口相关并发症发生率高于非紫绀型 CHD 婴儿。
我们回顾性分析了 2013 年至 2018 年间心脏手术后接受胃造口纽扣放置的 CHD 患者。患者分为紫绀型 CHD 和非紫绀型 CHD 队列。从胸外科医师协会数据库中提取患者数据，并与从图表审查中获得的与胃造口术放置和并发症相关的临床数据合并。使用 t 检验或 Wilcoxon 秩和检验（取决于正态性）对连续数据进行未调整分析，使用 χ 检验或 Fisher 确切检验（取决于分布）对分类数据进行未调整分析，以寻找与紫绀型 CHD 和非紫绀型 CHD 相关的协变量。
在研究期间，有 257 例 CHD 婴儿接受了胃造口术，其中 86 例为紫绀型 CHD。两组间基线体重或术前白蛋白水平无显著差异。紫绀型 CHD 患者合并症发生率较低（P = 0.0001），胸外科医师协会-欧洲心胸外科学会评分较高（P < 0.0001），术后死亡率较高（P = 0.0189）。非紫绀型 CHD 患者肉芽组织形成率较高（48.5% 与 22.1%，P < 0.0001）。胃造口纽扣相关并发症（包括渗漏、伤口感染或移位）发生率无差异。
非紫绀型 CHD 患者的肉芽组织发生率较高。两组间胃造口术特有的并发症发生率无差异，除肉芽组织形成外。基于这项研究，紫绀型 CHD 的诊断不会增加胃造口相关并发症的风险。
