Zlotolow Morgan, Mpody Christian, Carrillo Sergio A, Elmitwalli Islam, Nazir Wajahat, Nafiu Olubukola O, Tobias Joseph D
Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
J Pediatr Surg. 2024 Nov;59(11):161676. doi: 10.1016/j.jpedsurg.2024.08.016. Epub 2024 Aug 14.
Children with congenital heart disease (CHD) often require other, non-cardiac related surgical procedures following their initial cardiac surgery. After full or partial CHD repair, they remain at increased risk of postoperative complications. We examined the association of previous cardiac intervention (surgery or percutaneous catheterization intervention) with postoperative pneumonia in infants undergoing abdominal general surgery.
A 1:1 propensity score-matched study was conducted using a retrospective cohort of 104,820 infants (<12 months) who had general abdominal surgeries between 2012 and 2022 in U.S. hospitals participating in the National Surgical Quality Improvement Program. The primary outcome was postoperative pneumonia within 30 days. Secondary outcomes included unplanned reintubation, prolonged mechanical ventilation (>72 h), and extended hospital stay (>75th percentile for the study cohort).
Of the study cohort, 9736 infants (9.3%) had previous cardiac interventions. In the propensity score-matched sample, infants with previous cardiac surgery had increased risks of postoperative pneumonia (1.3% vs 0.8%; adjusted relative risk [RRadj]: 1.64, 95% CI: 1.22, 2.18, p = 0.001), unplanned reintubation (57.8% vs 32.6%; RRadj: 1.77, 95% CI: 1.77, 1.85, p < 0.001), prolonged mechanical ventilation (5.0% vs 2.3%; RRadj: 2.14, 95% CI: 1.83, 2.52, p < 0.001), and prolonged hospital stays (61.0% vs 53.8%; RRadj: 1.13, 95% CI: 1.10, 1.17, p < 0.001).
A history of previous cardiac intervention carries an increased risk of postoperative pneumonia, unplanned tracheal reintubation, prolonged mechanical ventilation, as well as longer hospital stays following intra-abdominal surgery. Clinicians should closely monitor these patients for respiratory complications after surgery.
II.
先天性心脏病（CHD）患儿在首次心脏手术后常需要进行其他与心脏无关的外科手术。在进行完全或部分CHD修复后，他们术后并发症的风险仍然较高。我们研究了既往心脏干预（手术或经皮导管介入）与接受腹部普通外科手术的婴儿术后肺炎之间的关联。
采用倾向评分1:1匹配研究，对2012年至2022年期间在美国参与国家外科质量改进计划的医院接受腹部普通外科手术的104820名婴儿（<12个月）进行回顾性队列研究。主要结局是30天内的术后肺炎。次要结局包括意外再次插管、机械通气时间延长（>72小时）和住院时间延长（超过研究队列的第75百分位数）。
在研究队列中，9736名婴儿（9.3%）有既往心脏干预史。在倾向评分匹配样本中，有既往心脏手术史的婴儿术后肺炎风险增加（1.3%对0.8%；调整后相对风险[RRadj]：1.64，95%CI：1.22，2.18，p = 0.001），意外再次插管风险增加（57.8%对32.6%；RRadj：1.77，95%CI：1.77，1.85，p < 0.001），机械通气时间延长风险增加（5.0%对2.3%；RRadj：2.14，95%CI：1.83，2.52，p < 0.001），住院时间延长风险增加（61.0%对53.8%；RRadj：1.13，95%CI：1.10，1.17，p < 0.001）。
既往心脏干预史会增加术后肺炎、意外气管再次插管、机械通气时间延长以及腹部手术后住院时间延长的风险。临床医生应密切监测这些患者术后的呼吸并发症。
II级。
