scholarly journals Impact of the nutritional status of children with congenital heart diseases on the early post-operative outcome

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Sameh R. Ismail ◽  
Akhter Mehmood ◽  
Noura Rabiah ◽  
Riyadh M. Abu-sulaiman ◽  
Mohamed S. Kabbani

Abstract Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Garrett A Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.


2019 ◽  
Vol 30 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Cortney B. Foster ◽  
Antonio G. Cabrera ◽  
Dayanand Bagdure ◽  
William Blackwelder ◽  
Brady S Moffett ◽  
...  

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.


2020 ◽  
Author(s):  
Hesham A. Abowali ◽  
Matteo Paganini ◽  
Garrett Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi

Abstract Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.


2019 ◽  
Vol 13 (S11) ◽  
Author(s):  
Juni Kurniawaty ◽  
Yunita Widyastuti

Abstract Background Patients with congenital heart disease require surgery to correct the cardiac defect they had in order to prevent heart failure. Unfortunately, data regarding outcome of adult CHD in Indonesia is still limited. In contrast with developed countries, many congenital heart surgery patients in developing countries are adults. The purpose of this study was to investigate the outcomes of cardiac surgery procedures among adult congenital heart disease patients, and what factors that might influence the outcome of surgery. Methods A retrospective study was performed on adult congenital heart disease patients undergoing cardiac surgery at Dr. Sardjito Hospital between April 2018 and March 2019. Variables included in the study were demographic characteristics, laboratory test results, comorbidities, premedication, Cardiopulmonary Bypass (CPB) and ischemia duration were included in the analysis. Outcomes were in-hospital mortality, hospital length of stay, and ICU length of stay. Results A total of 25 congenital heart disease patients [19 Atrial Septeal Defect (ASD) patients, and 6 Ventricular Septal Defect (VSD) patients] underwent a cardiac surgery procedure at Dr. Sardjito Hospital during the study period. Mean age was 31 ± 14.92 years. The majority of patients had pulmonary hypertension. During the study period, none of the patients died during postoperative care in the hospital, mean hospital length of stay (LOS) was 8.35 ± 3.39 days and ICU LOS was 26.53 ± 11.33 h. Conclusion Surgery in adult patients with congenital heart disease may be successfully performed with low morbidity and mortality.


2021 ◽  
pp. 026010602110090
Author(s):  
Sophie Hogan ◽  
Daniel Steffens ◽  
Kenneth Vuong ◽  
Anna Rangan ◽  
Michael Solomon ◽  
...  

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. Aim: To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. Methods: A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. Results: Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022). Conclusions: Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.


Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.


2020 ◽  
Vol 40 ◽  
pp. 577
Author(s):  
V. Raoult ◽  
D. Guimber ◽  
N. Peretti ◽  
H. Piloquet ◽  
R. Hankard ◽  
...  

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