Mortality due to illness after congenital heart surgery may be preventable
ORLANDO, Fla. — Among patients with congenital heart disease who have prolonged critical illness after surgery, mortality appears to be driven primarily by preventable characteristics, according to findings presented at the American College of Cardiology Scientific Session.
Aaron G. DeWitt, MD, attending cardiologist in the division of cardiac critical care medicine at Children’s Hospital of Philadelphia, and colleagues investigated the extent to which mortality for patients with congenital heart disease due to prolonged critical illness after surgery may be preventable.
“Patients with prolonged critical illness stuck in the ICU are a challenging population,” DeWitt told Cardiology Today. “Not a lot is known and written about these children, and we wanted to learn more.”
The researchers analyzed 13,106 surgical episodes from 23 hospitals participating in the Pediatric Cardiac Critical Care Consortium and defined prolonged critical illness as at least 35 days after surgery in neonates and at least 10 days after surgery in non-neonates. There were 242 neonates and 1,184 non-neonates with prolonged critical illness.
Among neonates, 24% with prolonged critical illness and 5% without it died in the cardiac ICU, and among non-neonates, 8% with prolonged critical illness and 0.4% without it died in the cardiac ICU, according to the researchers.
Among those with prolonged critical illness, the median number of complications was higher in those who died (neonates: 6 vs. 3; P < .0001; non-neonates: 6 vs. 2; P < .0001).
DeWitt and colleagues identified the following independent predictors of mortality after prolonged critical illness in neonates and non-neonates: mechanical ventilation days, cardiac arrest, renal replacement therapy and unplanned reoperation (P < .05 for all).
Time to freedom from vasoactive agents was a predictor of mortality in neonates, whereas use of nitric oxide, preoperative comorbidities and mechanical circulatory support predicted mortality in non-neonates, according to the researchers.
Nonpreventable patient and operative characteristics such as prematurity, extracardiac and chromosomal abnormalities and surgical complexity were not associated with mortality.
“A lot of the care factors we thought contributed to mortality didn’t,” DeWitt told Cardiology Today. “The patient and operative factors did not seem to be very important. It was patient care factors such as time on a ventilator or on inotropic support, or complications such as needing extracorporeal membrane oxygenation and having repeat surgeries for residual lesions that predicted mortality.”
De-identified data from the study are available to all institutions in Pediatric Cardiac Critical Care Consortium, so “they can see where the higher-performing centers are, and can discuss with the higher-performing centers about what they are doing, which could lead to quality improvements,” DeWitt said. – by Erik Swain
DeWitt A, et al. Abstract 1297-362. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: DeWitt reports no relevant financial disclosures.