Refining The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model With Enhanced Risk Adjustment for Chromosomal Abnormalities, Syndromes, and Noncardiac Congenital Anatomic Abnormalities

Background: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. Methods: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. Results: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. Conclusions: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.

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DEVELOPMENT OF AN AHRQ QUALITY INDICATOR BASED ON RISK ADJUSTMENT FOR CONGENITAL HEART SURGERY (RACHS-1)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)61599-5 ◽

2013 ◽

Vol 61 (10) ◽

pp. E1599

Author(s):

Kathy J. Jenkins ◽

Kimberlee Gauvreau ◽

Patrick Romano ◽

Jeffrey Geppert

Keyword(s):

Risk Adjustment ◽

Quality Indicator ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery

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Predictive value of paediatric risk of mortality score and risk adjustment for congenital heart surgery score after paediatric open-heart surgery

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2007.157917 ◽

2007 ◽

Vol 6 (5) ◽

pp. 628-631 ◽

Cited By ~ 21

Author(s):

L. Mildh ◽

V. Pettila ◽

H. Sairanen ◽

P. Rautiainen

Keyword(s):

Risk Adjustment ◽

Predictive Value ◽

Congenital Heart ◽

Heart Surgery ◽

Open Heart Surgery ◽

Congenital Heart Surgery ◽

Open Heart ◽

Risk Of Mortality

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P0331 / #765: PREDICTING SURGICAL MORTALITY AFTER CONGENITAL HEART SURGERIES USING RISK ADJUSTMENT IN CONGENITAL HEART SURGERY-1(RACHS-1) RISK SCORING SYSTEM: A RETROSPECTIVE ANALYSIS IN A SINGLE TERTIARY CENTER

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000739664.05052.af ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 178-178

Author(s):

S.M. Bajracharya

Keyword(s):

Risk Adjustment ◽

Scoring System ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Surgical Mortality ◽

System A ◽

Tertiary Center ◽

Risk Scoring ◽

Risk Scoring System

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A retrospective study of perioperative clinical seizures and epilepsy in children after operation for CHD

Cardiology in the Young ◽

10.1017/s1047951121005011 ◽

2021 ◽

pp. 1-7

Author(s):

Takeshi Ikegawa ◽

Shin Ono ◽

Kouji Yamamoto ◽

Mikihiro Shimizu ◽

Sadamitsu Yanagi ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

White Matter ◽

Risk Adjustment ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

White Matter Integrity ◽

Partial Regression Coefficient ◽

Clinical Seizure

Abstract This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.

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