Brody School of Medicine at East Carolina University, Greenville, NC, USA.
ECU Health Medical Center, Greenville, NC, USA.
Am Surg. 2024 Nov;90(11):2832-2839. doi: 10.1177/00031348241256081. Epub 2024 May 22.
Congenital heart disease (CHD) is one the most common congenital anomalies, with a prevalence of 8-10 cases per 1000 live births in the United States. Congenital heart disease has been recognized as a risk factor for poor perioperative and postoperative outcomes in non-cardiac surgery. We aimed to determine if documentation of CHD-related diagnosis codes was associated with similar risks for trauma surgery.
Data were acquired from the 2010-2019 American College of Surgeons' Trauma Quality Programs Participant Use Files. This study included trauma patients of all ages with one or more surgical procedures and at least one documented non-trauma (comorbidity) International Classification of Diseases code. Patients were stratified based on presence of CHD-related comorbidity codes vs any other comorbidity. Outcomes included mortality, hospital length of stay (LOS), discharge disposition, and in-hospital complications.
Using 1:1 propensity score matching, we matched 215 cases with CHD-related comorbid diagnoses to non-CHD controls. Compared to patients with other comorbidities, patients with CHD-related comorbidites were less likely to be discharged home to self-care (odds ratio: 0.44, 95% confidence interval [CI]: 0.25, 078 = .005) and tended to have prolonged hospital LOS (incidence rate ratio [IRR]: 1.06, 95% CI: 1.001, 1.13, = .046).
We present the first quantitative multicenter analysis correlating documentation of comorbid CHD-related diagnoses with higher risk of adverse outcomes after trauma surgery. These results support the need to routinely acknowledge and document CHD as comorbidity in trauma admissions that could lead to surgical intervention and for trauma centers to prepare for patients with a possible CHD comorbidity.
先天性心脏病（CHD）是最常见的先天性畸形之一，在美国每 1000 例活产中就有 8-10 例。先天性心脏病已被认为是非心脏手术围手术期和术后结局不佳的危险因素。我们旨在确定 CHD 相关诊断代码的记录是否与创伤手术的类似风险相关。
数据来自 2010 年至 2019 年美国外科医师学院创伤质量计划参与者使用文件。本研究包括所有年龄段的创伤患者，他们接受了一次或多次手术，并且至少有一个记录的非创伤（合并症）国际疾病分类代码。患者根据是否存在 CHD 相关合并症代码与任何其他合并症进行分层。结果包括死亡率、住院时间（LOS）、出院去向和院内并发症。
使用 1:1 倾向评分匹配，我们将 215 例存在 CHD 相关合并症诊断的病例与非 CHD 对照组进行匹配。与患有其他合并症的患者相比，患有 CHD 相关合并症的患者更不可能出院回家进行自我护理（优势比：0.44，95%置信区间 [CI]：0.25，0.78 =.005），并且住院 LOS 延长的趋势（发病率比 [IRR]：1.06，95%CI：1.001，1.13，=.046）。
我们首次进行了定量多中心分析，将合并 CHD 相关诊断的记录与创伤手术后不良结局的风险增加相关联。这些结果支持在需要进行手术干预的创伤入院时，常规承认和记录 CHD 作为合并症的必要性，并支持创伤中心为可能患有 CHD 合并症的患者做好准备。
