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Congenital cardiac surgical complications of the integument, vascular system, vascular-line(s), and wounds: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

  • Henry L. Walters (a1), Howard E. Jeffries (a2), Gordon A. Cohen (a3) and Thomas Klitzner (a4)

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to a collection of loosely related topics that include the following groups of complications: 1) Complications of the Integument, 2) Complications of the Vascular System, 3) Complications of the Vascular-Line(s), 4) Complications of Wounds. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Corresponding author
Correspondence to: Henry L. Walters III, MD, Department of Cardiovascular Surgery, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. Tel: 313 745 5538; Fax: 313 993 0531; E-mail:
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1. KM McLane , K Bookout , S McCord , J McCain , LS Jefferson . The 2003 national pediatric pressure ulcer and skin breakdown prevalence study. J Wound Ostomy Continence Nurs 2004; 31: 168178.

2. MJ Russell , M Gaetz . Intraoperative electrode burns. J Clin Monit Comput 2004; 18: 2532.

3. TW Lee , TM Chen , TY Cheng , Skin injury in the operating room. Injury 1998; 29: 345347.

4. O Nahlieli , AM Baruchin , D Levi , Y Shapira , B Yoffe . Povidone-Iodine related burns. Burns 2001; 27: 185188.

5. E Demir , DM O’Dey , N Pallua . Accidental burns during surgery. J Burn Care & Res 2006; 27: 895900.

8. SM Quigley , MAQ Curley . Skin integrity in the pediatric population: Preventing and managing pressure ulcers. J Soc Pediatr Nurs 1996; 1: 718.

9. MB Zollo , ML Gotisha , RJ Berens , JE Schmidt , CG Weigle . Altered skin integrity in children admitted to a pediatric intensive care unit. J Nurs Care Qual 1996; 11: 6267.

12. MAQ Curley , AM Quigley , M Lin . Pressure ulcers in pediatric intensive care: Incidence and associated factors. Pediatr Crit Care Med 2003; 4: 284290.

13. MAQ Curley , IS Razmus , KE Roberts , D Wypij . Predicting pressure ulcer risk in pediatric patients: The Braden Q. Nurs Res 2003; 52: 2233.

14. B Huffines , MC Logsdon . The neonatal skin risk assessment scale for predicting skin breakdown in neonates. Issues Compr Pediatr Nurs 1997; 20: 103114.

16. BV Scheer , A Perel , UJ Pfeiffer . Clinical review: Complications and risk factors of peripheral arterial catheters used for hemodynamic monitoring in anesthesia and intensive care medicine. Crit Care 2002; 6: 198204.

17. AC Kahler , F Mirza . Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients. Pediatr Crit Care Med 2002; 3: 370374.

18. CR Fikar , S Koch . Etologic factors of acute aortic dissection in children and young adults. Clin Pediatr 2000; 39: 7180.

19. PO Daily , HW Trueblood , EB Stinson , RD Wuerflein , NE Shumway . Management of acute aortic dissections. Ann Thorac Surg 1970; 10: 237247.

21. AM Khan , S Jacobs . Trash feet after coronary angiography. Heart 2003; 89: 1718.

22. A Om , S Ellham , G DiSciasco . Cholesterol embolization: An underdiagnosed clinical entity. Am Heart J 1992; 124: 13211326.

24. JM Journeycake , GR Buchanan . Thrombotic complications of central venous catheters in children. Curr Opin Hematol 2003; 10: 369374.

25. M Hausler , D Hubner , T Delhaas , EG Muhler . Long term complications of inferior vena cava thrombosis. Arch Dis Child 2001; 85: 228233.

26. A Shefler , J Gillis , A Lam , AJ O’Connell , A Lammi . Inferior vena cava thrombosis as a complication of femoral vein catheterization. Arch Dis Child 1995; 72: 343345.

27. LA Mermel , BM Farr , RJ Sherertz , Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001; 32: 12491272.

29. VA Olbrecht , CJ Barreiro , PN Bonde , Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg 2006; 82: 902908.

30. F Robicsek , A Fokin , J Cook , D Bhatia . Sternal instability after midline sternotomy. J Thorac Cardiovasc Surg 2000; 48: 18.

32. AL Allpress , GL Rosenthal , KM Goodrich , FM Lupinetti , DM Zerr . Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J 2004; 23: 231234.

33. TA Tortoriello , JD Friedman , ED Mckenzie , Mediastinitis after pediatric cardiac surgery: A 15-year experience at a single institution. Ann Thorac Surg 2003; 76: 16551660.

34. CB Long , SS Shah , E Lautenbach , Postoperative mediastinitis in children: Epidemiology, microbiology and risk factors for gram-negative pathogens. Pediatr Infect Dis J 2005; 24: 315319.

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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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