Hyperlactataemia as a predictor of adverse outcomes post-cardiac surgery in neonates with congenital heart disease

2021 ◽  
pp. 1-6
Author(s):  
Eleonore Valencia ◽  
Steven J. Staffa ◽  
Meena Nathan ◽  
Melissa Smith-Parrish ◽  
Aditya K. Kaza ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Single Ventricle ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Characteristic Analysis ◽  
Discriminative Ability ◽  
Peak Lactate

Abstract Objective: To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery. Methods: Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children’s hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score. Results: Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3 mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87). Conclusions: We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.

Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Davide Cao ◽  
Matthew A Levin ◽  
Samantha Sartori ◽  
Anastasios Roumeliotis ◽  
Rishi Chandiramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Bleeding Events ◽  
Target Vessel Revascularization ◽  
Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

Clinical Features and Outcomes in 545 Patients with Heparin-Induced Thrombocytopenia: A 6-Year Review from the CAMC HIT Registry.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1052-1052
Author(s):  
James N. Frame ◽  
Elaine A. Davis ◽  
Ying Wang ◽  
Joan Reed
Keyword(s):  
Cardiac Surgery ◽  
Median Time ◽  
Clinical Features ◽  
Tertiary Care ◽  
Bleeding Event ◽  
Hospital Length Of Stay ◽  
Composite Outcome ◽  
All Cause Mortality ◽  
The Mean ◽  
Morbid Conditions

Abstract Purpose: To describe the clinical features and outcomes of pts. with HIT over a 6-year period from a tertiary care medical center. Design: Retrospective case series of 545 pts. enrolled in an IRB-approved HIT Registry from 1/1/99 to 12/31/05. Measurements: demographics, co-morbid conditions, HIT presentations, platelet ct./HIT antibody results, treatment, hospital length of stay (LOS), composite outcome, and all-cause mortality. Results: Median age-68 yrs.; 47%-females; 97%-caucasians. Co-morbid conditions: HTN (78%), coronary artery disease (73%), diabetes mellitus (42%), CHF (16%), ESRD on dialysis (5.7%) and active malignancy (4.2%). Clinical HIT settings included: adult open heart surgery (OHS)-69%, medical-23% and non-cardiac surgery-8%. Cardiac medical pts. comprised 50% of the medical cohort. Among the OHS, medical and non-cardiac surgery HIT cohorts, HIT occurred during the hospitalization with UFH exposure in 322 (59%), 125 (23%), and 39 (7.2%) pts., respectively. In these respective clinical HIT settings, delayed-onset HIT (D-HIT) developed after discharge from a hospitalization with UFH exposure in 54 (10%), 2 (0.36%), and 3 (0.55%) pts. During the study period, HIT was diagnosed in 2.5% of 15,152 OHS pts. The median time from UFH initiation to the time when HIT was first clinically suspected and diagnosed was 7 days and 10 days, respectively. The median time from UFH discontinuation to the time HIT was first clinically suspected and diagnosed was 1 and 4 days, respectively. Of 537 pts. in whom an H-PF4 ELISA (GTI) or HIPA assay or both were performed, 85% had at least one positive result. The median platelet ct. at baseline (last platelet ct. at hospital D/C for D-HIT), at the time HIT was first clinically suspected and at in-hospital HIT nadir was 209,500/mm3, 77,000/mm3 and 62,000/mm3, respectively. At HIT presentation, 53% had thrombocytopenia alone, 33% had both thrombocytopenia and thromboembolic complications (TEC) and 9.7% had TEC alone. At least one anticoagulant therapy was administered in 89.7% and varied by agent availability, clinical setting or physician selection: Argatroban (51.7%), lepirudin (36.5%), bivalirudin (4.4%), and danaparoid sodium (2.9%). The mean treatment durations on a DTI alone (n=479 pts.) or with subsequent warfarin co-therapy (n=368 pts.) were 9.7 days and 5.4 days, respectively. A new TEC after HIT diagnosis, major bleeding event or amputation occurred in 13%, 7.5%, and 1.8% (composite outcome: 22.6%). Of 446 (82%) pts. surviving to hospital D/C, 84.8% were on warfarin therapy alone. The mean HIT hospital LOS was 21.3 days. The all-cause mortality (ACM) was 18.2% with a quarterly-calculated linear trend in reduction over time (p=0.07). A 56% reduction in the annual ACM was observed from a peak of 28.8% in 2000 to 12.8% in 2005. Significant multivariate predictors of ACM included: TEC presentation (OR 2.09; 95% CI 1.33–3.28; p=0.001) and DTI use (OR 0.48; 95% CI 0.26–0.89; p=0.021). Conclusions: In this HIT Registry 6-year review, HIT developed most frequently after OHS with a frequency of 2.5%. Fifty percent of medical HIT cases occurred in cardiac pts. Ninety-six percent presented with thrombocytopenia, TEC, or both. D-HIT developed following hospital discharge in 16% of OHS HIT pts. HIT survivorship was observed in 82%. The composite outcome was 22.6%. A strong trend for ACM reduction was observed. In a multivariate analysis, ACM was significantly influenced by a TEC presentation and DTI use.

Clinical Features and Outcomes in Patients with Heparin-Induced Thrombocytopenia (HIT): Report of the CAMC HIT Registry.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2069-2069 ◽  
Author(s):  
James N. Frame ◽  
Elaine Davis ◽  
Joan Reed ◽  
Ying Wang ◽  
Mary Emmett
Keyword(s):  
Cardiac Surgery ◽  
Clinical Features ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Thrombin Inhibitor ◽  
Graft Occlusion ◽  
Composite Outcome ◽  
Platelet Counts ◽  
Specific Mortality

Abstract In 2001, our tertiary-care academic medical center implemented a HIT Task Force to develop quality improvement (QI) initiatives for HIT (Blood. 102:2766a, 2003). From these initiatives, a CAMC IRB-approved HIT Registry was developed. We present, from inpatient (IP) Registry data, a retrospective analysis of the clinical features/outcomes of patients (pts) reported/identified with clinical HIT from Jan 1999 to June 2003. IP medical records for case selection were identified from archival pharmacy records, the laboratory records of HIT antibody (Ab) assays, and case-reporting. Demographic features, co-morbid conditions, HIT-cohorts, HIT frequency in open heart surgery (OHS) pts, platelet counts (baseline; time HIT 1st suspected, nadir), thromboembolic complications (TEC), HIT Ab testing (H-PF4 ELISA;HIPA), agents utilized for HIT treatment, mean hospital length of stay (LOS), individual/composite outcomes of new TEC, amputations, and all-cause or HIT-specific mortality are presented. Clinical HIT was identified or recorded in 285 pts: 1999: 35, ‘00: 66, ‘01:63, ‘02:67, 1–6.30.03: 54. The median age was 68 yrs (range, 26–90). M/F (%): 47/53. Co-morbidities included coronary artery disease (68%), hyperlipidemia (49%), diabetes mellitus (40%), renal failure (4.6%), active malignancy (2.5%). The median/mean time from initiating heparin (H) to HIT recognition was 8.7/5.0 days. Median platelet counts (mm3) at baseline/time HIT was 1st suspected/HIT nadir were 208,000/72,000/53,000. A H-PF4 or HIPA assay was (+) in 80% (228). HIT cohorts included OHS (187; 66%), medical admission (69; 24%), & non-cardiac surgery (29; 10%) pts. HIT was identified following IP discharge (D/C) in 19% (35/187) of OHS and 10% (3/29) of non-cardiac surgery pts. The OHS HIT frequency among total OHS pts was: 1.8% (187/10,529). TEC at HIT presentation was 43% (123) and included (> 1 event/pt may have occurred): DVT (101), PE (17), graft occlusion (17), MI (10), venous gangrene (4), TIA (4). A new TEC occurred in 14% (41). Anticoagulant therapy for HIT was administered in 88% of Registry pts: r-hirudin (56%), Argatroban (26%) and danaparoid (6%). The mean duration of direct thrombin inhibitor (DTI) therapy/warfarin overlap with a DTI was 8.9 days /4.5 days. Warfarin was administered at D/C in 78% (176/225) pts. The HIT-admission mean LOS was 21days. The all-cause/HIT-specific mortality was 21% (60)/14% (39). Major bleeding /amputation occurred in 9.0%/2.4%. The composite outcome of new TEC, amputation and all-cause death was 26% (75/285). This report is among the largest reported hospital experiences. HIT was identified most frequently after OHS. Delayed HIT after hospital D/C occurred in 13%. Outcomes comparable to prior reports include time to HIT development, clinical HIT Ab detection, OHS HIT frequency, baseline/new TEC, alternative anticoagulant use, all-cause mortality and the composite outcome. QI initiatives arising from this analysis emphasize initiating DTI therapy when HIT 1st suspected and warfarin when platelets are sufficiently recovered; incorporating a prospective tool for scoring the likelihood of HIT; detailed analyses of the delayed-onset HIT cohort and assessing the financial impact of HIT in hospitalized pts.

scholarly journals Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

2012 ◽  
Vol 03 (01) ◽  
pp. 28-35 ◽  
Author(s):  
Aliasgar V Moiyadi ◽  
Prakash M Shetty
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Brain Tumors ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Related Factors ◽  
Important Indicator ◽  
Systemic Complications

ABSTRACT Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

scholarly journals Patients with Single-Ventricle Physiology over the Age of 40 Years

2020 ◽  
Vol 9 (12) ◽  
pp. 4085
Author(s):  
Claudia Pujol ◽  
Sandra Schiele ◽  
Susanne J. Maurer ◽  
Julia Hock ◽  
Celina Fritz ◽  
...  
Keyword(s):  
Renal Disease ◽  
Single Ventricle ◽  
Independent Predictor ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Single Ventricle Physiology ◽  
All Cause Mortality

Background: Single-ventricle physiology (SVP) is associated with significant morbidity and mortality at a young age. However, survival prospects have improved and risk factors for a negative outcome are well described in younger cohorts. Data regarding older adults is scarce. Methods: In this study, SVP patients under active follow-up at our center who were ≥40 years of age at any point between January 2005 and December 2018 were included. Demographic data, as well as medical/surgical history were retrieved from hospital records. The primary end-point was all-cause mortality. Results: Altogether, 49 patients (19 female (38.8%), mean age 49.2 ± 6.4 years) were included. Median follow-up time was 4.9 years (interquartile range (IQR): 1.8–8.5). Of these patients, 40 (81.6%) had undergone at least one cardiac surgery. The most common extracardiac comorbidities were thyroid dysfunction (n = 27, 55.1%) and renal disease (n = 15, 30.6%). During follow-up, 10 patients (20.4%) died. On univariate analysis, renal disease and liver cirrhosis were predictors of all-cause mortality. On multivariate analysis, only renal disease (hazard ratio (HR): 12.5, 95% confidence interval (CI): 1.5–106.3, p = 0.021) remained as an independent predictor. Conclusions: SVP patients ≥40 years of age are burdened with significant morbidity and mortality. Renal disease is an independent predictor of all-cause mortality.

Outcomes for unplanned reinterventions following paediatric cardiac surgery for tetralogy of Fallot

2021 ◽  
pp. 1-6
Author(s):  
Asaad G. Beshish ◽  
Elizabeth B. Aronoff ◽  
Nikita Rao ◽  
Mohua Basu ◽  
Tawanda Zinyandu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Native American ◽  
Tetralogy Of Fallot ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Genetic Syndromes ◽  
Retrospective Case ◽  
Entire Cohort

Abstract Background: Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. Methods: We conducted a single-centre retrospective case–control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. Results: During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). Conclusion: Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

2020 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Operative Time ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

scholarly journals Cardiac Surgery Conduct during COVID-19 Pandemic

2020 ◽  
Vol 4 (02) ◽  
pp. 091-095
Author(s):  
Manoj Kumar Sahu ◽  
Prateek Vaswani ◽  
Amitabh Satsangi ◽  
Sarvesh Pal Singh ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Surgery ◽  
Tertiary Care ◽  
Institutional Development ◽  
Resource Conservation ◽  
Conservation Strategy ◽  
Entire Study ◽  
Strict Adherence ◽  
Surgical Practice ◽  
Valvular Heart Diseases

Abstract Background Health care is seriously affected by the coronavirus disease 2019 (COVID-19) pandemic with alarming effects upon conduct of cardiac surgery. The initial resource conservation strategy has to modify for handling the surging case load due to deference of routine care in the face of pandemic. Methods The cardiac surgical practice during the lockdown period (from 25th march till 25th June) at a tertiary care centre was observed. The cardiac diagnosis of the ones operated, conduct algorithm, and working policy were analyzed. Descriptive statistics was applied to calculate the percentages of different case subsets in both adult and pediatric groups. Results A total of 93 cardiac patients were consecutively operated during the 3 months’ period in two cardiac theatres of a total eight dedicated and were rotated cyclically. A total of 37 (39.78%) adult cardiac surgeries were performed out of 93 cases, with coronary artery bypass grafting (11.83%: 11/93) and valvular heart diseases (11.83%: 11/93) constituting the majority. Pediatric cardiac surgeries constituted 56 cases (60.21%) which comprised of arterial switch operation (19.35%), total anomalous pulmonary venous connection (8.60%), and Blalock Taussig shunts (7.53%) predominantly. There was no COVID-19-related mortality and none of the health-care workers developed COVID-19 in the entire study period. Conclusions The initial phase of resource conservation has undermined the routine cardiac surgical practice. The study showed that strict adherence to management algorithm is necessary for persisting smooth continuation of cardiac surgical practice with provision of optimum critical care. The strategic comeback against COVID-19 would urge institutional development of protocols to aid the post-surge period.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

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