Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T08:10:28.008Z Has data issue: false hasContentIssue false
  • English
  • Français

RACHS-1 score as predictive factor for postoperative ventilation time in children with congenital heart disease

Published online by Cambridge University Press:  17 January 2020

Luisa Geier ,
Christoph Menzel ,
Ingo Germund  and
Uwe Trieschmann Open the ORCID record for Uwe Trieschmann [Opens in a new window]
Luisa Geier
Affiliation:
Department of Pediatrics, Sana-Klinikum Remscheid, Remscheid, Germany
Christoph Menzel
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Koln, Germany
Ingo Germund
Affiliation:
Department of Paediatric Cardiology, University Hospital Aachen, Aachen, Germany
Uwe Trieschmann*
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Koln, Germany
*
Author for correspondence: U. Trieschmann, MD, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937Köln, Germany. Tel: +49 221 478 84504; Fax: +49 221 478 1484504; E-mail: uwe.trieschmann@uk-koeln.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Congenital heart disease is the most frequent malformation in newborns. The postoperative mortality of these patients can be assessed with the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score. This study evaluates whether the RACHS-1 score can also be used as a predictor for the length of postoperative ventilation and what is the influence of age.

Material and Methods:

In a retrospective study over the period from 2007 to 2013, all patient records were evaluated: 598 children with congenital heart disease and cardiac surgery were identified and 39 patients have been excluded because of additional comorbidities. For evaluation of mortality, 559 patients could be analysed, after exclusion of 39 deceased patients, 520 cases remained for analysis of postoperative ventilation.

Results:

Overall mortality was 7% with a dependency on RACHS-1 categories. The median length of postoperative ventilation rose according to the RACHS-1 categories: RACHS-1 category 1: 9 hours (interquartile range (IQR) 7–13 hours), category 2: 30 hours (IQR 12–85 hours), category 4: 58 hours (IQR 13–135 hours), category 4: 71 hours (IQR 29–165 hours), and category 6: 189 hours (IQR 127–277 hours). Some of the RACHS-1 subgroups differed significantly from the categories, especially the repair of tetralogy of Fallot with a longer ventilation time and strong variability. Younger age was an independent factor for longer postoperative ventilation.

Conclusion:

RACHS-1 is a good predictor for the length of postoperative ventilation after cardiac surgery with the exception of some subgroups. Younger age is another independent factor for longer postoperative ventilation. These data provide better insight into ventilation times and allow better planning of operations in terms of available intensive care beds.

Keywords

Paediatric intensive carepaediatric cardiac surgeryRACHS-1 scorepostoperative ventilationrisk factors
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 2 , February 2020 , pp. 213 - 218
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Boneva, RS, Botto, LD, Moore, CA, Yang, Q, Correa, A, Erickson, JD.Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 2001; 103: 2376–2381.10.1161/01.CIR.103.19.2376CrossRefGoogle ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI.Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
Boethig, D, Jenkins, KJ, Hecker, H, Thies, WR, Breymann, T.The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population. Eur J Cardiothorac Surg 2004; 26: 12–17.10.1016/j.ejcts.2004.03.039CrossRefGoogle Scholar
Larsen, SH, Pedersen, J, Jacobsen, J, Johnsen, SP, Hansen, OK, Hjortdal, V.The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease. Eur J Cardiothorac Surg 2005; 28: 877–881.10.1016/j.ejcts.2005.09.008CrossRefGoogle Scholar
Simsic, JM, Cuadrado, A, Kirshbom, PM, Kanter, KR.Risk Adjustment for Congenital Heart Surgery (RACHS): is it useful in a single-center series of newborns as a predictor of outcome in a high-risk population? Congenit Heart Dis 2006; 1: 148–151.10.1111/j.1747-0803.2006.00026.xCrossRefGoogle Scholar
Polito, A, Patorno, E, Costello, JM, et al.Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med 2011; 12: e122–e126.CrossRefGoogle ScholarPubMed
Padley, JR, Cole, AD, Pye, VE, et al.Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease. Heart Lung Circ 2011; 20: 460–467.10.1016/j.hlc.2011.03.009CrossRefGoogle ScholarPubMed
Szekely, A, Sapi, E, Kiraly, L, Szatmari, A, Dinya, E.Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth 2006; 16: 1166–1175.Google ScholarPubMed
Nakayama, Y, Shibasaki, M, Shime, N, Nakajima, Y, Mizobe, T, Sawa, T.The RACHS-1 risk category can be a predictor of perioperative recovery in Asian pediatric cardiac surgery patients. J Anesth 2013; 27: 850–854.10.1007/s00540-013-1645-1CrossRefGoogle ScholarPubMed
Jacobs, JP, Mayer, JE Jr., Mavroudis, C, et al.The society of thoracic surgeons congenital heart surgery database: 2016 update on outcomes and quality. Ann Thorac Surg 2016; 101: 850–862.CrossRefGoogle Scholar
Odek, C, Kendirli, T, Ucar, T, et al.Predictors of early extubation after pediatric cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 2016; 37: 1241–1249.10.1007/s00246-016-1423-6CrossRefGoogle ScholarPubMed
Jochman, JD, Atkinson, DB, Quinonez, LG, Brown, ML.Twenty years of anesthetic and perioperative management of patients with tetralogy of Fallot with absent pulmonary valve. J Cardiothorac Vasc Anesth 2017; 31: 918–921.10.1053/j.jvca.2017.02.006CrossRefGoogle ScholarPubMed
Li, S, Zhang, Y, Li, S, et al.Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenit Heart Dis 2015; 10: 254–262.10.1111/chd.12205CrossRefGoogle ScholarPubMed
van Dongen, EI, Glansdorp, AG, Mildner, RJ, et al.The influence of perioperative factors on outcomes in children aged less than 18 months after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2003; 126: 703–710.10.1016/S0022-5223(03)00035-7CrossRefGoogle ScholarPubMed
Jacobs, ML, O’Brien, SM, Jacobs, JP, et al.An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg 2013; 145: 1046–1057.10.1016/j.jtcvs.2012.06.029CrossRefGoogle ScholarPubMed
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: 1139–1153.10.1016/j.jtcvs.2009.03.071CrossRefGoogle ScholarPubMed
Tabib, A, Abrishami, SE, Mahdavi, M, Mortezaeian, H, Totonchi, Z.Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease. Res Cardiovasc Med 2016; 5: e30391.10.5812/cardiovascmed.30391CrossRefGoogle ScholarPubMed
Traiber, C, Piva, JP, Fritsher, CC, et al.Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units. Pediatr Crit Care Med 2009; 10: 375–380.10.1097/PCC.0b013e3181a3225dCrossRefGoogle ScholarPubMed
Rooney, SR, Donohue, JE, Bush, LB, et al.Extubation failure rates after pediatric cardiac surgery vary across hospitals. Pediatr Crit Care Med 2019; 20: 450–456.10.1097/PCC.0000000000001877CrossRefGoogle ScholarPubMed
Zhang, CY, Tan, LH, Shi, SS, et al.Noninvasive ventilation via bilevel positive airway pressure support in pediatric patients after cardiac surgery. World J Pediatr 2006; 2: 297–302.Google Scholar
Silva, CR, Andrade, LB, Maux, DA, Bezerra, AL, Duarte, MC.Effectiveness of prophylactic non-invasive ventilation on respiratory function in the postoperative phase of pediatric cardiac surgery: a randomized controlled trial. Braz J Phys Ther 2016; 20: 494–501.10.1590/bjpt-rbf.2014.0191CrossRefGoogle ScholarPubMed