Department of Pediatrics, University of California San Francisco, San Francisco, Calif; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, Calif.
Department of Pediatrics, University of California San Francisco, San Francisco, Calif; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, Calif.
J Thorac Cardiovasc Surg. 2021 Dec;162(6):1838-1847.e4. doi: 10.1016/j.jtcvs.2021.01.065. Epub 2021 Jan 29.
We hypothesized that infants with fetal growth restrictions have increased mortality and morbidity after congenital heart disease surgery.
The study included patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2016) who underwent cardiac surgery at a corrected gestational age of ≤44 weeks. Patients were classified as severely (birth weight Z-score -4 to -2), moderately (Z-score -2 to -1), and mildly growth restricted (Z-score -1.0 to -0.5) and compared with a reference population (Z-score 0-0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality and postoperative complications and its interaction with gestational age was assessed.
In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared with the reference group, the adjusted odds ratio (AOR) of mortality was increased in infants with severe (AOR, 2.4; 95% confidence interval [CI], 2.0-3.0), moderate (AOR, 1.7; 95% CI, 1.4-2.0), and mild growth restriction (AOR, 1.4; 95% CI, 1.2-1.6). The AOR for major postoperative complications was increased for severe (AOR, 1.4; 95% CI, 1.2-1.7) and moderate growth restriction (AOR, 1.2; 95% CI, 1.1-1.4). There was significant interaction between birth weight Z-score and gestational age (P = .007).
Even birth weight Z-scores slightly below average are independent risk factors for mortality and morbidity in infants who undergo cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term infants. These novel findings might account for some of the previously unexplained variation in cardiac surgical outcomes.
我们假设胎儿生长受限的婴儿在先天性心脏病手术后的死亡率和发病率增加。
这项研究纳入了 2010 年至 2016 年在胸外科医生学会先天性心脏病外科学数据库中接受过胎龄校正至≤44 周心脏手术的患者。患者分为严重（出生体重 Z 评分-4 至-2）、中度（Z 评分-2 至-1）和轻度生长受限（Z 评分-1.0 至-0.5），并与参考人群（Z 评分 0-0.5）进行比较。采用基于中心的多变量逻辑回归聚类来评估出生体重 Z 评分与手术死亡率和术后并发症的相关性，并评估其与胎龄的相互作用。
在 25244 名患者中，手术死亡率为 8.6%，主要并发症发生率为 19.4%。与参考组相比，严重（比值比 [AOR]，2.4；95%置信区间 [CI]，2.0-3.0）、中度（AOR，1.7；95% CI，1.4-2.0）和轻度生长受限（AOR，1.4；95% CI，1.2-1.6）的婴儿死亡率调整比值比（AOR）增加。严重（AOR，1.4；95% CI，1.2-1.7）和中度生长受限（AOR，1.2；95% CI，1.1-1.4）的主要术后并发症 AOR 也增加。出生体重 Z 评分和胎龄之间存在显著的交互作用（P=0.007）。
即使出生体重 Z 评分略低于平均值，也是行心脏手术婴儿死亡率和发病率的独立危险因素。在早期婴儿中，胎儿生长不良与手术死亡率之间的关联最强。这些新发现可能解释了一些先前无法解释的心脏外科学结果的差异。
