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An index for evaluating results in paediatric cardiac intensive care

Published online by Cambridge University Press:  14 July 2006

Sandra S. Mattos ,
Juliana R. Neves ,
Mônica C. Costa ,
Thamine P. Hatem  and
Carlos F. Luna
Sandra S. Mattos
Affiliation:
Unidade de Cardiologia & Medicina Fetal, Real Hospital Português, Recife, Brazil
Juliana R. Neves
Affiliation:
Unidade de Cardiologia & Medicina Fetal, Real Hospital Português, Recife, Brazil
Mônica C. Costa
Affiliation:
Unidade de Cardiologia & Medicina Fetal, Real Hospital Português, Recife, Brazil
Thamine P. Hatem
Affiliation:
Unidade de Cardiologia & Medicina Fetal, Real Hospital Português, Recife, Brazil
Carlos F. Luna
Affiliation:
NESC, Laboratório de Métodos Quantitativos em Saúde, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Ministério da Saúde, Brazil
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Abstract

Objective: To determine if in-hospital mortality after cardiac surgery can be predicted, in children, using a new clinical and surgical index. Study design: Observational, retrospective, cross-sectional. Methods: We reviewed 818 charts from children undergoing surgery between January, 2000, and December, 2004. The index was calculated by summing the scores from five variables, specifically age, nutritional state, the presence of associated clinical risk factors, surgical complexity, and use and time of cardiopulmonary bypass. Each variable was subdivided into categories of low, medium or high risk, with scores attributed as zero, one or two, respectively. Risks for death were calculated using the odds ratio. Results: Our overall mortality was 14.7%, with our proposed index correlating strongly with mortality (p less than 0.0001). No patients died with scores of zero, but mortality increased from around 10% with a score of three, to close to 30% with scores of five and six, and to over 50% with a score of eight. No patients reached scores of 10, and more than three-fifths of all patients had scores between zero and three. We observed higher mortalities independently for each variable in association with the highest risk scores. Conclusions: We found that surgery undertaken in the neonatal period, weight below the 5th percentile, the presence of associated clinical risk factors, operations of higher complexity, and more than 90 minutes of cardiopulmonary bypass were all significantly associated with mortality. Our suggested new index showed a linear correlation with mortality, and in our current experience, has proved a valuable tool for predicting adverse outcomes.

Keywords

Paediatric cardiac surgeryrisk factorscongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 4 , August 2006 , pp. 369 - 377
Copyright
© 2006 Cambridge University Press

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References

Hannan E, Racz M, Kavey R, Quaegebeur JM, Williams R. Paediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 1998; 101: 963–969.Google Scholar
Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283: 1191–1193.Google Scholar
Stark J, Gallivan S, Lovegrove J, et al. Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 2000; 355: 1004–1007.Google Scholar
Chang RK, Klitzner TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 2002; 109: 173–181.Google Scholar
Knaus WA, Wagner DP, Zimmerman JE, Draper EA. Variations in mortality and length of stay in intensive care units. Ann Inter Med 1993; 118: 753–761.Google Scholar
Tilford JM, Simpson PM, Green JW, Lensing S, Fiser DH. Volume-outcome relationships in paediatric intensive care units. Pediatrics 2000; 106: 289–294.Google Scholar
Moore JWM, Beekman III RH, Case CL, et al. Guidelines for paediatric cardiovascular centers. American Academy of Paediatrics. Pediatrics 2002; 109: 544–549.Google Scholar
Grech V, Elliott MJ. Evolution of surgical trends in congenital heart disease: a population based study. Int J Cardiol 1998; 66: 285–292.Google Scholar
Chang RK, Chen AY, Klitzner TS. Factors associated with age at operation for children with congenital heart disease. Pediatrics 2000; 105: 1073–1081.Google Scholar
Texas Health Care Information Council. Texas Hospital Inpatient Discharge Public Use Data File, 2001.
Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 1995; 95: 323–330.Google Scholar
Trittenwein G, Nardi A, Pansi H, et al. Early postoperative prediction of cerebral damage after paediatric cardiac surgery. Ann Thorac Surg 2003; 76: 576–580.Google Scholar
Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 2003; 31: 28–33.Google Scholar
Shime N, Kageyama K, Ashida H, Ueda M, Kitamura Y, Tanaka Y. Perioperative assessment of blood lactate levels in paediatric heart surgery. Masui 2001; 50: 752–757.Google Scholar
Boigner H, Brannath W, Hermon M. Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery. Ann Thorac Surg 2004; 77: 61–65.Google Scholar
Ben-Abraham R, Efrati O, Mishali D, et al. Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children. J Crit Care 2002; 17: 235–239.Google Scholar
Parvathy U, Balakrishnan KR, Ranjith MS, Saldanha R, Sai S, Vakamudi M. Surgical experience with congenital heart disease in Down's syndrome. Indian Heart J 2000; 52: 438–441.Google Scholar
Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997; 112: 666–675.Google Scholar
Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. Churchill Livingstone, New York, 1993.
Pons LH, Vieira JGH, De Carvalho WB, Chwals WJ. The role of insulin-like growth factor I, growth hormone, and plasma proteins in surgical outcome of children with congenital heart disease. Pediatr Crit Care Med 2001; 2: 29–35.Google Scholar
Casey WF, Hauser GJ, Hannallah RS, Midgley FM, Khan WN. Circulating endotoxin and tumor necrosis factor during paediatric cardiac surgery. Crit Care Med 1992; 20: 1090–1096.Google Scholar
Pollack MM, Ruttimann UE, Getson PR. Paediatric risk of mortality (PRISM) score. Crit Care Med 1988; 16: 1110–1116.Google Scholar
Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated Paediatric Risk of Mortality score. Crit Care Med 1996; 24: 743–752.Google Scholar
Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 1997; 23: 201–207.Google Scholar
Pollack MM, Cuerdon TC, Getson PR. Paediatric intensive care units: results of a national survey. Crit Care Med 1993; 21: 607–613.Google Scholar
Jones GD, Thorburn K, Tigg A, Murdoch IA. Preliminary data: PIM vs. PRISM in infants and children post cardiac surgery in a UK PICU. Intensive Care Med 2000; 26: 145.Google Scholar
Zobel G, Rodl S, Rigler B, et al. Prospective evaluation of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery. J Cardiovasc Surg 1993; 34: 333–337.Google Scholar
Lacour-Gayet F, Clarke D, Jacobs J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.Google Scholar
National Centre for Health Statistics in: http://www.cdc.gov/growthcharts.
Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery or congenital heart disease. J Thorac Cardiovasc Surg 2003; 123: 111–118.Google Scholar