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Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

Published online by Cambridge University Press:  03 September 2020

Igor V. Polivenok ,
William M. Novick Open the ORCID record for William M. Novick [Opens in a new window] ,
Aleksander V. Pyetkov  and
Marcelo Cardarelli
Igor V. Polivenok
Affiliation:
Zaitcev V.T. Institute of General and Urgent Surgery, Kharkiv, Ukraine William Novick Global Cardiac Alliance, Memphis, TN, USA
William M. Novick*
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA University of Tennessee Health Science Center - Global Surgery Institute, Memphis, TN, USA
Aleksander V. Pyetkov
Affiliation:
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Marcelo Cardarelli
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA Pediatric Cardiac Surgery, Inova Children’s Hospital, Fairfax, VA, USA
*
Author for correspondence: W. M. Novick, MD, 1750 Madison Ave., Suite 500, Memphis, TN38104, USA. Tel: +1-901-438-9413. E-mail: bill.novick@cardiac-alliance.org
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Abstract

Background:

The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.

Aim:

To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.

Methods:

Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.

Results:

Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).

Conclusions:

In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

Keywords

Paediatric cardiac surgerypost-operative carecomplicationsCHD
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1659 - 1665
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Ferraris, VA, Ferraris, SP. Risk factors for postoperative morbidity. J Thorac Cardiovasc Surg 1996; 111: 731–738. doi: 10.1016/s0022-5223(96)70333-1 CrossRefGoogle ScholarPubMed
Benavidez, OJ, Gauvreau, K, Del Nido, P, et al. Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 2007; 84: 147–155. doi: 10.1016/j.athoracsur.2007.02.048 CrossRefGoogle ScholarPubMed
Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. What is operative morbidity? Defining complications in a surgical registry database. Ann Thorac Surg 2007; 84: 1416–1421. doi: 10.1016/j.athoracsur.2007.07.085 CrossRefGoogle Scholar
Shearer, B, Marshall, S, Buist, MD, et al. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare services. BMJ Qual Saf 2012; 21: 569–575. doi: 10.1136/bmjqs-2011-000692 CrossRefGoogle Scholar
Donohue, LA, Endacott, R. Track, trigger and teamwork: communication of deterioration in acute medical and surgery wards. Intensive Crit Care Nurs 2010; 26: 10–17. doi: 10.1016/j.iccn.2009.10.006 CrossRefGoogle Scholar
de Leval, MR, Carthey, J, Wright, DJ, et al. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000; 119 (Pt 1): 661–672. doi: 10.1016/S0022-5223(00)70006-7 CrossRefGoogle ScholarPubMed
Ghaferi, AA, Birkmeyer, JD, Dimick, JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 2009; 250: 1029–1034. doi: 10.1097/sla.0b013e3181bef697 CrossRefGoogle ScholarPubMed
Pasquali, SK, He, X, Jacobs, JP, et al. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of The STS Congenital Heart Surgery Database. Ann Thorac Surg 2012; 94: 573–580. doi: 10.1016/j.athoracsur.2012.03.065 CrossRefGoogle ScholarPubMed
Walker, IA, Reshamwalla, S, Wilson, IH. Surgical safety checklists: do they improve outcomes? Br J Anaesth 2012; 109: 47–54. doi: 10.1093/bja/aes175 CrossRefGoogle ScholarPubMed
Hodgetts, TJ, Kenward, G, Vlachonikolis, IG, et al. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation 2002; 54: 125–131. doi: 10.1016/s0300-9572(02)00100-4 CrossRefGoogle ScholarPubMed
Johnston, M, Arora, S, King, D, et al. Escalation of care and failure to rescue: a multi-center, multi-professional qualitative study. Surgery 2014; 155: 989–994. doi: 10.1016/j.surg.2014.01.016 CrossRefGoogle Scholar
Polivenok, IV, Molloy, FJ, Gilbert, CL, et al. Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre. Cardiol Young 2019; 29: 363–368. doi: 10.1017/S1047951118002457 CrossRefGoogle Scholar
O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 1139–1153. doi: 10.1016/j.jtcvs.2009.03.071 CrossRefGoogle ScholarPubMed
Society of Thoracic Surgery Congenital Database Committee. STS Congenital Database Full Specifications Version: 2.50. Available at: http://www.sts.org/sites/default/files/documents/pdf/Congenital_DataSpecs_250.pdf Google Scholar
Agarwal, HS, Wolfram, KB, Saville, BR, et al. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2014; 148: 609–616. doi: 10.1016/j.jtcvs.2013.10.031 CrossRefGoogle ScholarPubMed
Belliveau, D, Burton, HJ, O’Blenes, SB, et al. Real-time complication monitoring in pediatric cardiac surgery. Ann Thorac Surg 2012; 94: 1596–1603. doi: 10.1016/j.athoracsur.2012.05.103 CrossRefGoogle ScholarPubMed
Pasquali, SK, Li, JS, Burstein, DS, et al. Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics 2012; 129: e370–e376. doi: 10.1542/peds.2011-1188 CrossRefGoogle ScholarPubMed
Chan, T, Lion, KC, Mangione-Smith, R. Racial disparities in failure-to-rescue among children undergoing congenital heart surgery. J Pediatr 2015; 166: 812–818.e1–4. doi: 10.1016/j.jpeds.2014.11.020 CrossRefGoogle ScholarPubMed
Althabe, M, Rodríguez, RR, Balestrini, M, et al. Morbidity in congenital heart surgery in a public hospital in Argentina. Arch Argent Pediatr 2018; 116: e14–e18. doi: 10.5546/aap.2018.eng.e14 Google Scholar
Pattisan, N, Eastham, E. Critical care outreach referrals: a mixed-method investigative study of outcomes and experiences. Nurs Crit Care 2012; 17: 71–82. doi: 10.1111/j.1478-5153.2011.00464.x CrossRefGoogle Scholar
Downey, AW, Quach, J, Haase, M, et al. Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med 2008; 36: 477–481. doi: 10.1097/01.CCM.0000300277.41113.46 CrossRefGoogle ScholarPubMed
Calzavacca, P, Liuari, E, Tee, A, et al. A prospective study of factors influencing the outcome of patients after a medical emergency team review. Intensive Care Med 2008; 34: 2112–2116. doi: 10.1007/s00134-008-1229-y CrossRefGoogle ScholarPubMed
Alsoufi, B, Al-Radi, OO, Gruenwald, C, et al. Extra-corporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardiothorac Surg 2009; 35: 1004–1011. doi: 10.1016/j.ejcts.2009.02.015 CrossRefGoogle ScholarPubMed
Sivarajan, VB, Almodovar, MC, Rodefeld, MD, et al. Pediatric extracorporeal life support in Specialized Situations. Pediatr Crit Care Med 2013; 14 (5 Suppl 1): S51–S61. doi: 10.1097/PCC.0b013e318292e16e CrossRefGoogle ScholarPubMed
Özker, E, Saritaş, B, Vuran, C, et al. Delayed sternal closure after pediatric cardiac operations; single center experience: a retrospective study. J Cardiothorac Surg 2012; 7: 102. doi: 10.1186/1749-8090-7-102 CrossRefGoogle ScholarPubMed
Nelson-McMillan, K, Hornik, CP, He, X, et al. Delayed sternal closure in infant heart surgery-the importance of where and when: an analysis of the STS congenital heart surgery database. Ann Thorac Surg 2016; 102: 1565–1572. doi: 10.1016/j.athoracsur.2016.08.081 CrossRefGoogle ScholarPubMed
Hurtado-Sierra, D, Calderón-Colmenero, J, Curi-Curi, P, et al. Outcomes of delayed sternal closure in pediatric heart surgery: Single-center experience. Biomed Res Int 2018; 2018: 3742362. doi: 10.1155/2018/3742362 CrossRefGoogle ScholarPubMed
Tabbutt, S, Duncan, BW, McLaughlin, D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997; 113: 886–893. doi: 10.1016/S0022-5223(97)70261-7 CrossRefGoogle Scholar
McElhinney, D, Reddy, V, Johnson, L, et al. Open sternotomy and delayed sternal closure following cardiac surgery in neonates: outcomes of a strategy for managing critically Ill patients 202. Pediatr Res 1997; 41: 36. doi: 10.1203/00006450-199704001-00222 CrossRefGoogle Scholar
Balachandran, R, Kappanayil, M, Sen, AC, et al. Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy. Ann Card Anaesth 2015; 18: 52–57. doi: 10.4103/0971-9784.148322 Google Scholar
Jenkins, KJ, Castaneda, AR, Cherian, KM, et al. Reducing mortality and infection after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–e1430. doi: 10.1542/peds.2014-0356 CrossRefGoogle ScholarPubMed