Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

AbstractIntroduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.

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Risk Factors for Nosocomial Infections in a Critically Ill Pediatric Population: A 25-Month Prospective Cohort Study

Infection Control and Hospital Epidemiology ◽

10.1086/501770 ◽

2000 ◽

Vol 21 (5) ◽

pp. 340-342 ◽

Cited By ~ 32

Author(s):

Alfredo E. Gilio ◽

Adalberto Stape ◽

Crésio R. Pereira ◽

Maria Fátima S. Cardoso ◽

Claudia V. Silva ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Critically Ill ◽

Nosocomial Infections ◽

Pediatric Population ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Utilization Ratio

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05-5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

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Perioperative Stroke, Encephalopathy, and Central Nervous System Dysfunction

Journal of Intensive Care Medicine ◽

10.1177/088506669701200305 ◽

1997 ◽

Vol 12 (3) ◽

pp. 148-160 ◽

Cited By ~ 5

Author(s):

Dennis T. Mangano ◽

Christina Mora Mangano

Keyword(s):

Health Care ◽

Central Nervous System ◽

Clinical Trials ◽

Nervous System ◽

Cardiac Surgery ◽

Length Of Stay ◽

Large Scale ◽

Morbidity And Mortality ◽

Health Care Resources ◽

Prolonged Length

The leading cause of mortality in adult populations throughout the world is atherosclerosis, which results in cardiovascular and cerebrovascular complications and consumes substantive health care resources. The impact of atherosclerosis on patients undergoing surgery is also considerable, given the multiple stresses occurring during, and especially following, the surgical procedures, thereby precipitating vascular morbidity. Perioperative cerebrovascular morbidity and mortality occur in approximately 10% of the 600,000 patients who undergo cardiac surgery annually, consuming approximately $13 billion, which is expended on in-hospital, intensive care unit (ICU), and long-term specialized care for these neurological complications of stroke, encephalopathy, and cognitive dysfunction. Furthermore, risk of these outcomes will continue to increase as the surgical population ages. Principal among the etiologies of focal stroke and encephalopathy appear to be perioperative hypotension and precipitation of macroemboli and microemboli. As a result, new detection techniques for these events have been instituted, including (1) continuous hemodynamic monitoring, for detection of hypotensive episodes; (2) transesophageal echocardiography, for detection of aortic atherosclerosis, a potential source for emboli; and (3) transcranial Doppler sonography, for detection of cerebral emboli, as well as determination of cerebral blood flow. Recent large-scale multicenter studies have identified risk factors and indices for perioperative central nervous system (CNS) morbidity. Regarding therapy, a number of pharmacological approaches are currently under consideration; principal among these approaches are agents that can modulate the excitotoxic response, including glutamate receptor antagonists (NMDA, AMPA, metabotrophic), calcium channel blockers, free radical scavengers, and agents that modify the inflammatory white cell response. Although a number of laboratory, animal, and smaller clinical trials have been conducted, only one large-scale multicenter program to date has been conducted to assess the efficacy of adenosine modulation. These data, collected in more than 4,000 patients undergoing cardiac surgery, suggest that in addition to mitigation of myocardial injury, stroke also may be modulated by enhancing adenosine concentration in the area of cerebral ischemia. However, these preliminary findings must be validated in appropriately powered clinical trials. Finally, postoperative stroke and encephalopathy consume substantive resources, resulting in prolonged length-of-stay (17 days in-hospital 10 days for patients suffering Q-wavc infarction, vs 7 days for patients having no adverse outcome) and prolonged length-of-stay in the ICU following surgery (5 vs 3 vs 2 days, respectively). Hospital costs increase by approximately 3- to 4-fold in patients who suffer CNS outcomes following surgery. In conclusion, perioperative CNS morbidity and mortality is a critical problem that affects a substantial portion of the surgical population and consumes considerable health care resources. Over the next several years, attention must be focused on this important problem, and clinical and research resources should be redirected toward the solution of perioperative CNS morbidity.

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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951120003637 ◽

2020 ◽

pp. 1-8

Author(s):

Santosh Kaipa ◽

Mouhammad Yabrodi ◽

Brian D. Benneyworth ◽

Eric S. Ebenroth ◽

Christopher W. Mastropietro

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Confidence Interval ◽

Odds Ratio ◽

Aortic Coarctation ◽

Patient Characteristics ◽

Oral Feeding ◽

Prolonged Length ◽

Independent Risk Factors ◽

Neonates And Infants

Abstract Objective: We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation. Methods: We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay. Results: We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay. Conclusions: In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.

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Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

Infection Control and Hospital Epidemiology ◽

10.1086/668439 ◽

2013 ◽

Vol 34 (1) ◽

pp. 24-30 ◽

Cited By ~ 70

Author(s):

Cecile Aubron ◽

Allen C. Cheng ◽

David Pilcher ◽

Tim Leong ◽

Geoff Magrin ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Extracorporeal Membrane Oxygenation ◽

Unit Length ◽

Severity Of Illness ◽

Infectious Complications ◽

Hospital Length ◽

Interquartile Range ◽

Hospital Length Of Stay ◽

Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

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Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Hospital Pediatrics ◽

10.1542/hpeds.2014-0246 ◽

2015 ◽

Vol 5 (9) ◽

pp. 461-473 ◽

Cited By ~ 15

Author(s):

S. V. Kaiser ◽

L.-A. Bakel ◽

M. J. Okumura ◽

A. D. Auerbach ◽

J. Rosenthal ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Prolonged Length

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Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2021-0219 ◽

2021 ◽

Vol 74 (suppl 6) ◽

Author(s):

Monica Taminato ◽

Richarlisson Borges de Morais ◽

Dayana Souza Fram ◽

Rogério Rodrigues Floriano Pereira ◽

Cibele Grothe Esmanhoto ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Kidney Transplant ◽

Multidrug Resistant ◽

Morbidity And Mortality ◽

Epidemiological Surveillance ◽

Resistant Bacteria ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Tract Infections

ABSTRACT Objectives: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. Methods: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. Results: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. Conclusions: colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.

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Risk factors for prolonged length of stay after colorectal surgery

Journal of Coloproctology ◽

10.1016/j.jcol.2013.02.001 ◽

2013 ◽

Vol 33 (1) ◽

pp. 22-27 ◽

Cited By ~ 6

Author(s):

Luiz Felipe de Campos Lobato ◽

Patrícia Cristina Alves Ferreira ◽

Elizabeth C. Wick ◽

Ravi P. Kiran ◽

Feza H. Remzi ◽

...

Keyword(s):

Risk Factors ◽

Colorectal Surgery ◽

Length Of Stay ◽

Prolonged Length

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Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951119002634 ◽

2019 ◽

Vol 29 (12) ◽

pp. 1501-1509 ◽

Cited By ~ 5

Author(s):

Ahmed M. Dohain ◽

Gaser Abdelmohsen ◽

Ahmed A. Elassal ◽

Ahmed F. ElMahrouk ◽

Osman O. Al-Radi

Keyword(s):

Cardiac Surgery ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Discharge ◽

University Hospital ◽

P Value ◽

Biventricular Repair ◽

Factors Affecting ◽

Membrane Oxygenation ◽

Paediatric Cardiac Surgery ◽

Neonates And Infants

AbstractBackground:Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.Materials and methods:We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.Results:The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients’ age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.Conclusion:Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

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