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Prolonged length of stay after surgery for adult congenital heart disease: a single-centre study in a developing country

Published online by Cambridge University Press:  15 July 2020

Russell S. Martins Open the ORCID record for Russell S. Martins [Opens in a new window] ,
Zaiba S. Dawood ,
Muhammad K. Y. Memon  and
Saleem Akhtar
Russell S. Martins
Affiliation:
Medical College, Aga Khan University Hospital, Karachi74800, Pakistan
Zaiba S. Dawood
Affiliation:
Medical College, Aga Khan University Hospital, Karachi74800, Pakistan
Muhammad K. Y. Memon
Affiliation:
Department of Pediatrics, Liaquat National Hospital & Medical College, Karachi74800, Pakistan
Saleem Akhtar*
Affiliation:
Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi74800, Pakistan
*
Author for correspondence: Saleem Akhtar, Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi74800, Pakistan. Tel: +92-307-2393757. E-mail: saleem.sadqani@aku.edu
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Abstract

Background:

With the growing number of adults requiring operations for CHD, prolonged length of stay adds an additional burden on healthcare systems, especially in developing countries. This study aimed to identify factors associated with prolonged length of stay in adult patients undergoing operations for CHD.

Methods:

This retrospective study included all adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011 to 2016 at a tertiary-care private hospital in Pakistan. Prolonged length of stay was defined as hospital stay >75th percentile of the overall cohort (>8 days).

Results:

This study included 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years. Comorbid disease was present in 59.0% of patients. Most patients underwent atrial septal defect repair (42.2%). A total of 38 (22.9%) patients had a prolonged length of stay. Post-operative complications occurred in 38.6% of patients. Multivariable analysis showed that pre-operative body mass index (odds ratio: 0.779; 95% confidence interval: 0.620–0.980), intraoperative aortic cross-clamp time (odds ratio: 1.035; 95% confidence interval: 1.009–1.062), and post-operative acute kidney injury (odds ratio: 7.392; 95% confidence interval: 1.036–52.755) were associated with prolonged length of stay.

Conclusion:

Predictors of prolonged length of stay include lower body mass index, longer aortic cross-clamp time, and development of post-operative acute kidney injury. Shorter operations, improved pre-operative nutritional optimisation, and timely management of post-operative complications could help prevent prolonged length of stay in patients undergoing operations for adult CHD.

Keywords

Adult CHDlength of staydeveloping countryCHD surgeryprolonged length of stay
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 9 , September 2020 , pp. 1253 - 1260
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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