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Prospective evaluation of acute neurological events after paediatric cardiac surgery

Published online by Cambridge University Press:  14 March 2024

Olivia Frost Open the ORCID record for Olivia Frost [Opens in a new window] ,
Deborah Ridout ,
Warren Rodrigues ,
Paul Wellman ,
Jane Cassidy ,
Victor T. Tsang ,
Dan Dorobantu ,
Serban C. Stoica ,
Aparna Hoskote  and
Katherine L. Brown Open the ORCID record for Katherine L. Brown [Opens in a new window]
Olivia Frost
Affiliation:
Institute of Cardiovascular Science, University College London, London, UK St George’s Medical School, University of London, London, UK
Deborah Ridout
Affiliation:
Population, Policy and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, UK
Warren Rodrigues
Affiliation:
Heart and Lung Division, Great Ormond Street Hospital, London, UK Department of Paediatric Cardiac Surgery, Royal Hospital for Children Glasgow, Glasgow, UK
Paul Wellman
Affiliation:
Departments of Paediatric Cardiology, Intensive Care and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
Jane Cassidy
Affiliation:
Department of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
Victor T. Tsang
Affiliation:
Institute of Cardiovascular Science, University College London, London, UK Heart and Lung Division, Great Ormond Street Hospital, London, UK
Dan Dorobantu
Affiliation:
Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
Serban C. Stoica
Affiliation:
Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
Aparna Hoskote
Affiliation:
Institute of Cardiovascular Science, University College London, London, UK Heart and Lung Division, Great Ormond Street Hospital, London, UK
Katherine L. Brown*
Affiliation:
Institute of Cardiovascular Science, University College London, London, UK Heart and Lung Division, Great Ormond Street Hospital, London, UK
*
Corresponding author: K. Brown; Email: katherine.brown@gosh.nhs.uk
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Abstract

Objectives:

Children with CHD are at heightened risk of neurodevelopmental problems; however, the contribution of acute neurological events specifically linked to the perioperative period is unclear.

Aims:

This secondary analysis aimed to quantify the incidence of acute neurological events in a UK paediatric cardiac surgery population, identify risk factors, and assess how acute neurological events impacted the early post-operative pathway.

Methods:

Post-operative data were collected prospectively on 3090 consecutive cardiac surgeries between October 2015 and June 2017 in 5 centres. The primary outcome of analysis was acute neurological event, with secondary outcomes of 6-month survival and post-operative length of stay. Patient and procedure-related variables were described, and risk factors were statistically explored with logistic regression.

Results:

Incidence of acute neurological events after paediatric cardiac surgery in our population occurred in 66 of 3090 (2.1%) consecutive cardiac operations. 52 events occurred with other morbidities including renal failure (21), re-operation (20), cardiac arrest (20), and extracorporeal life support (18). Independent risk factors for occurrence of acute neurological events were CHD complexity 1.9 (1.1–3.2), p = 0.025, longer operation times 2.7 (1.6–4.8), p < 0.0001, and urgent surgery 3.4 (1.8–6.3), p < 0.0001. Unadjusted comparison found that acute neurological event was linked to prolonged post-operative hospital stay (median 35 versus 9 days) and poorer 6-month survival (OR 13.0, 95% CI 7.2–23.8).

Conclusion:

Ascertainment of acute neurological events relates to local measurement policies and was rare in our population. The occurrence of acute neurological events remains a suitable post-operative metric to follow for quality assurance purposes.

Keywords

Cardiac surgeryCHDpaediatric neurologypaediatric cardiologypost-operative outcomes
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 9
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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