Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, South Carolina.
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, South Carolina.
Ann Thorac Surg. 2023 Aug;116(2):358-364. doi: 10.1016/j.athoracsur.2022.10.020. Epub 2022 Oct 28.
Truncus arteriosus repair is associated with higher morbidity and mortality compared with many other congenital heart operations. We sought to determine factors associated with mortality and adverse outcomes in infants undergoing truncus arteriosus repair.
We used the Pediatric Health Information System Database to identify infants aged < 90 days who underwent truncus arteriosus repair from 2004 to 2019. The primary outcome was hospital mortality. Secondary outcomes were prolonged postoperative length of stay (>30 days) and hospital readmission within 90 days. Multivariable logistic regression models were used to identify associated factors for adverse outcomes.
A total of 1645 subjects were included. Hospital mortality occurred in 164 (10%). Factors independently associated with mortality included birth weight < 3 kg, admit age < 48 hours, truncal valve surgery, cardiac arrest, extracorporeal membrane oxygenation, acute kidney injury, cardiac catheterization, tracheostomy, and earlier era. Prolonged postoperative length of stay occurred in 508 patients (31%). Factors independently associated with prolonged postoperative length of stay included prematurity, DiGeorge syndrome, admit age < 48 hours, later surgical era, acute kidney injury, infection, cardiac catheterization, vocal cord paralysis, tracheostomy, and gastrostomy. Readmission within 90 days occurred in 511 of 1481 surviving patients (34%). DiGeorge syndrome, cleft lip/palate, cardiac catheterization, and extracorporeal membrane oxygenation were factors independently associated with hospital readmission.
We identified multiple factors associated with hospital mortality and adverse outcomes in infants undergoing truncus arteriosus repair. This information is useful for quality improvement initiatives, perioperative counseling, and discharge planning.
与许多其他先天性心脏病手术相比，动脉干修复术相关的发病率和死亡率更高。我们旨在确定接受动脉干修复术的婴儿死亡和不良结局的相关因素。
我们使用儿科健康信息系统数据库，确定 2004 年至 2019 年间年龄<90 天的接受动脉干修复术的婴儿。主要结局为院内死亡率。次要结局为术后住院时间延长（>30 天）和 90 天内再次住院。多变量逻辑回归模型用于确定不良结局的相关因素。
共纳入 1645 例患者。院内死亡率为 164（10%）。与死亡率独立相关的因素包括出生体重<3kg、入院年龄<48 小时、动脉干瓣手术、心脏骤停、体外膜肺氧合、急性肾损伤、心导管检查、气管切开术和更早的时代。508 例（31%）患者术后住院时间延长。与术后住院时间延长独立相关的因素包括早产、DiGeorge 综合征、入院年龄<48 小时、较晚的手术时代、急性肾损伤、感染、心导管检查、声带麻痹、气管切开术和胃造口术。1481 例存活患者中，有 511 例（34%）在 90 天内再次住院。DiGeorge 综合征、唇裂/腭裂、心导管检查和体外膜肺氧合是与院内再次住院独立相关的因素。
我们确定了与动脉干修复术婴儿院内死亡率和不良结局相关的多个因素。这些信息对于质量改进计划、围手术期咨询和出院计划很有用。
