Abstract 4570: Association Between Intra-operative and Early Postoperative Glucose Levels and Adverse Outcomes Following Complex Congenital Heart Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Angelo Polito ◽  
Ravi R Thigarajan ◽  
Peter C Laussen ◽  
Kimberlee Gauvreau ◽  
Michael S Agus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Glucose Control ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Composite Endpoint ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Glucose Levels ◽  
Multiple Variables

Although hyperglycemia is associated with increased mortality in critically ill adults, studies in children undergoing cardiac surgery are limited and have reached conflicting conclusions. We sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization and morbid events following complex congenital heart surgery. Metrics of glucose control including average, peak, minimum and standard deviation of glucose levels, and duration of hyperglycemia (hours >126 mg/dL and 200 mg/dL) were determined intraoperatively and for 72 hours following surgery for 378 consecutive children who had a Risk Adjustment in Congenital Heart Surgery-1 category ≥3. Regression analyses were used to determine relationships between glucose variables, hospital length of stay and a composite morbidity-mortality outcome (death, ECMO, infection, hepatic injury, renal failure, and/or brain injury) after controlling for multiple variables known to influence early outcomes. Intraoperatively, a minimum glucose ≤75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 – 6.48), but other metrics of glucose control were not associated with the composite endpoint or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dl) during the first 72 postoperative hours was associated with longer duration of hospitalization (p<0.001). In the 72 hours after surgery, average glucose <110 mg/dl (OR, 7.30; 95% CI, 1.95–27.25) or >143 mg/dl (OR, 5.21, 95% CI, 1.37–19.89), minimum glucose ≤75 mg/dL (OR, 2.85, 95% CI, 1.38 –5.88), and peak glucose level ≥250 mg/dl (OR, 2.55, 95% CI, 1.20 –5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint. In children undergoing complex congenital heart surgery, intraoperative hyperglycemia was not associated with adverse outcomes. When considering analyses of several metrics of glucose control, the optimal postoperative glucose range may be 110 –126 mg/dl. A randomized trial of strict glycemic control achieved with insulin infusions in this patient population is needed.

scholarly journals Association Between Intraoperative and Early Postoperative Glucose Levels and Adverse Outcomes After Complex Congenital Heart Surgery

Circulation ◽  
2008 ◽  
Vol 118 (22) ◽  
pp. 2235-2242 ◽  
Author(s):  
Angelo Polito ◽  
Ravi R. Thiagarajan ◽  
Peter C. Laussen ◽  
Kimberlee Gauvreau ◽  
Michael S.D. Agus ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Glucose Levels

Alpha-blockade during congenital heart surgery admissions: analysis from national database

2021 ◽  
pp. 1-7
Author(s):  
Brian Lee ◽  
Enrique G. Villarreal ◽  
Emad B. Mossad ◽  
Jacqueline Rausa ◽  
Ronald A. Bronicki ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Alpha Blockade ◽  
Stay Hospital

Abstract Introduction: The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes. Materials and Methods: A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality. Results: Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges. Conclusions: Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

2019 ◽  
Vol 30 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Cortney B. Foster ◽  
Antonio G. Cabrera ◽  
Dayanand Bagdure ◽  
William Blackwelder ◽  
Brady S Moffett ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Diaphragm Dysfunction

AbstractBackground:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery

2021 ◽  
Author(s):  
Michelle Ramírez ◽  
Sujata Chakravarti ◽  
Jaclyn McKinstry ◽  
Yasir Al-qaqaa ◽  
Raj Sahulee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Stress Injury ◽  
Stage 1

Abstract Objectives: This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods: We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results: Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019). Conclusion: AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.

Surgical Site Infection After Pediatric Cardiothoracic Surgery

2016 ◽  
Vol 8 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Anthony A. Sochet ◽  
Alexander M. Cartron ◽  
Aoibhinn Nyhan ◽  
Michael C. Spaeder ◽  
Xiaoyan Song ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Heart Surgery ◽  
Hospital Costs ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Cardiothoracic Surgery ◽  
Hospital Length Of Stay ◽  
Published Data ◽  
Site Infection

Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

scholarly journals Preoperative Vitamin D Deficiency Is Associated With Higher Vasoactive-Inotropic Scores Following Pediatric Cardiac Surgery in Chinese Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Xiuxia Ye ◽  
Shumei Dong ◽  
Yujiao Deng ◽  
Chuan Jiang ◽  
Yanting Kong ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cardiac Surgery ◽  
Vitamin D Deficiency ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Cardiovascular Health ◽  
Univariate Analysis ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Total Serum

The relationship between vitamin D and cardiovascular health in children remains unclear. Vitamin D deficiency (VDD) is supposed to be a potential risk factor associated with poorer outcomes after congenital heart disease (CHD) surgery. The maximum vasoactive-inotropic use after cardiac surgery is considered to be a good predictor of adverse outcomes. We aimed to assess the correlation between preoperative VDD and the maximum vasoactive-inotropic score (VISmax) at 24 h postoperatively. Nine hundred children with CHD were enrolled in this study, and preoperative total serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by liquid chromatography-tandem mass spectrometry. Related demographic and clinical characteristics were collected. A total of 490 boys (54.4%) and 410 girls (45.6%) with a mean age of 1 year (range: 6 months-3 years) were enrolled. The median 25(OH)D level was 24.0 ng/mL, with 32.6% of patients having VDD [25(OH)D &lt; 20 ng/mL]. The univariate analysis indicated that VDD [odds ratio (OR): 2.27; 95% confidence interval (CI): 1.48–3.50] is associated with a risk of increased VISmax at 24 h postoperation. Multivariate analysis revealed that VDD (OR: 1.85; 95% CI: 1.09–3.02), a Risk-adjusted Congenital Heart Surgery score of at least three points (OR: 1.55; 95% CI: 1.09–2.19), and cardiopulmonary bypass time (OR: 1.02; 95% CI: 1.01–1.02) were independently associated with an increased VISmax within 24 h after cardiac surgery. VDD in pediatric patients before cardiac surgery is associated with the need for increased postoperative inotropic support at 24 h postoperation.

Abstract 220: Technical Performance Scores Predict Outcomes Following Congenital Heart Surgery: Multicenter Validation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Meena Nathan ◽  
Hua Liu ◽  
Steven D Colan ◽  
Lazaros Kochilas ◽  
Geetha Raghuveer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Assessment Tool ◽  
Multivariable Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length Of Stay ◽  
Atrioventricular Canal ◽  
Technical Performance

BACKGROUND: In previous work from a single center, Technical Performance Score (TPS), a tool that assesses technical adequacy of repair, has been shown to be strongly associated with outcomes in congenital cardiac surgery. We sought to validate the efficacy of TPS in a multicenter environment. METHODS: All patients (1 day to 62 years) who were discharged from January 1 to December 31, 2011; and who underwent 9 congenital cardiac procedures (Arterial switch operation [84], Bidirectional Glenn [75], Atrioventricular canal repair [135], Fontan [97], Arch repair on pump [58], Stage I Procedure [85], Pulmonary valve replacement [116], Tetralogy of Fallot repair [112], and Ventricular septal defect repair [163]); from 5 centers were included. Based on echocardiograms (echo) prior to discharge or death, and unplanned reinterventions at surgical site; TPS was assigned using previously established criteria. Case complexity was determined by RACHS-1 category. Outcomes included (a) major postoperative adverse events (AE) excluding unplanned reinterventions, (b) length of ventilation, and (c) postoperative hospital stay. Adjusted analysis used logistic/linear regression to determine odds ratio (OR) and regression coefficient (b) for each outcome. RESULTS: There were 925 hospital discharges: 418 (45%) were RACHS-1 category 2, 295 (32%) category 3, 85 (9%) category 4, 86 (9%) category 6 and the cohort included 41 (4%) adults. TPS were as follows: 491 (53%) class 1-optimal, 263 (28%) class 2-adequate, 131 (14%) class 3-inadequate and 40 (4%) had no TPS assigned because of a lack of or incomplete echos (NA). There were 26 (2.8%) deaths (81% of deaths were in class 3) and 105 (11%) adverse events. Occurrence of major adverse events, ventilation time and hospital length of stay were all significantly higher in class 3 (Figure). On multivariable analysis adjusting for age, RACHS-1, prematurity, and presence of non-cardiac anomalies; Class 3 TPS was associated with a higher odds of AE (OR 7.4, CI 4.1-13.2, p<0.001), longer ventilation (b 1.9, CI 1.6-2.2, p<0.001), and hospital stay (b 1.6, CI 1.4 to 1.8, p<0.001). CONCLUSION: TPS predicts outcomes after congenital heart surgery in a multicenter cohort, and can serve as quality assessment tool. Outcomes may be favorably influenced by focusing on technical excellence.

Sign in / Sign up

Export Citation Format

Share Document