Objective
To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions.
Methods
We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years.
Results
There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9% (22/202). It was much higher than those free from re-interventions (0.7%). Time of mechanical ventilation was 284.3 (11–2 339) h, and mean ICU stay was 17.7 (1–154) d, significantly longer than those free from re-interventions at the same period.
Conclusion
Unplanned re-interventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.
Citation：
YANG Juxian, WANG Xu, LI Shoujun, YAN Jun, ZENG Min, DUAN Leilei, LI Xia, LU Zhongyuan, YANG Xuefang, ZHENG Lin, ZHANG Hao. Unplanned re-intervention within 30 days after pediatric cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 372-377. doi: 10.7507/1007-4848.201712052
Copy
Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 1. 王冠英, 王宏斌, 郑新瑞, 等. 非计划二次手术监控的实践与思考. 中国医院, 2013,17(8): 26-27.
- 2. 陈虎, 焦雅辉, 赵明钢, 等. 北京市五家大型综合医院" 重返类”指标的比较分析. 中国卫生质量管理, 2010, 17(1): 4-7.
- 3. Wilson RM, Runciman WB, Gibberd RW,et al. The Quality in Australian Health Care Study.Med J Aust, 1995, 163(9): 458-471.
- 4. Pasquali SK, He X, Jacobs ML, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg, 2014, 98(5): 1660-1666.
- 5. Johnson EA, Zubair MM, Armsby LR, et al. Surgical quality predicts length of stay in patients with congenital heart disease. Pediatr Cardiol, 2016,37(3): 593-600.
- 6. Frösch U, Sengstbrat M, Huber J, et al. Unplanned reoperations for infection complications: a survey for quality control. Surg Infect (Larchmt). 2006, 7(3): 263-268.
- 7. Crawford TC, Magruder JT, Grimm JC, et al. Planned versus unplanned reexplorations for bleeding: a comparison of morbidity and mortality. Ann Thorac Surg, 2017, 103(3): 779-786.
- 8. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, et al. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg, 2011, 40(1): 179-84.
- 9. Sames-Dolzer E, Gierlinger G, Kreuzer M, et al. Unplanned cardiac reoperations and interventions during long-term follow-up after the Norwood procedure. Eur J Cardiothorac Surg, 2017, 51(6): 1044-1050.
- 10. O'Connor MJ, Ravishankar C, Ballweg JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg. 2011,142(1): 106-112.
