Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium,The Journal of Thoracic and Cardiovascular Surgery

当前位置： X-MOL 学术 › J. Thorac. Cardiovasc. Surg. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium
The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2022-06-02 , DOI: 10.1016/j.jtcvs.2022.05.029
Andrew H Smith ₁ , Andrew Y Shin ₂ , Sarah Tabbutt ₃ , Mousumi Banerjee ₄ , Wenying Zhang ₄ , Santiago Borasino ₅ , Justin J Elhoff ₆ , J William Gaynor ₇ , Nancy S Ghanayem ₈ , Sara K Pasquali ₉ , James D St Louis ₁₀ , Subhadra Shashidharan ₁₁ , Michael Ruppe ₁₂ , Kurt R Schumacher ₉ , Michael Gaies ₉ , John M Costello ₁₃

Affiliation

Division of Cardiac Critical Care Medicine, The Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Fla.
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, Calif.
Division of Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital and the University of California San Francisco Medical School, San Francisco, Calif.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich.
Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
Sections of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex.
Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Section of Pediatric Critical Care, Department of Pediatrics, University of Chicago Medicine, Chicago, Ill, and Advocate Children's Hospital, Oak Lawn, Ill.
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Mich.
Section of Pediatric and Congenital Heart Surgery, Medical College of Georgia, Augusta, Ga.
Department of Surgery, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, Ga.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Norton Healthcare, University of Louisville School of Medicine, Louisville, Ky.
Division of Cardiology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC.

Objective

The optimal timing for neonatal cardiac surgery is a potentially modifiable factor that may affect outcomes. We studied the relationship between age at surgery (AAS) and outcomes across multiple hospitals, focusing on neonatal operations where timing appears is not emergency.

Methods

We studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital on or before day of life 2 undergoing selected index cardiac operations. The impact of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup (ie, free of preoperative mechanical ventilation, mechanical circulatory support, or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic complication), and postoperative cardiac intensive care unit and hospital length of stay. Post hoc analyses focused on operations undertaken between day of life 2 and 7.

Results

We studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not associated with risk adjusted mortality or major morbidity among the entire cohort and the standard risk subgroup. Older AAS, although associated with modest increases in postoperative cardiac intensive care unit and hospital length of stay in the entire cohort, was not associated with hospital length of stay in the standard risk subgroup.

Conclusions

Among select nonemergency neonatal cardiac operations, AAS between day of life 2 and 7 was not found to be associated with risk adjusted mortality or major morbidity. Although delays in surgical timing may modestly increase preoperative resource use, studies of AAS and outcomes not evident at the time of discharge are needed.

中文翻译：

手术年龄和新生儿心脏手术后的结果：来自儿科心脏重症监护协会的分析

客观的

新生儿心脏手术的最佳时机是一个可能影响结果的潜在可变因素。我们研究了多家医院的手术年龄 (AAS) 与结果之间的关系，重点关注出现时机并非紧急情况的新生儿手术。

方法

我们研究了妊娠 ≥ 37 周且体重 ≥ 2.5 kg 的新生儿在出生后第 2 天或之前入院接受选定的心脏手术。AAS 对结果的影响在整个队列和标准风险亚组（即，无术前机械通气、机械循环支持或其他器官衰竭）中进行了评估。结果包括死亡率、主要发病率（即心脏骤停、机械循环支持、计划外心脏再介入或神经系统并发症），以及术后心脏重症监护病房和住院时间。事后分析侧重于生命第 2 天和第 7 天之间进行的操作。