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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Published online by Cambridge University Press:  26 November 2019

Cortney B. Foster Open the ORCID record for Cortney B. Foster [Opens in a new window] ,
Antonio G. Cabrera ,
Dayanand Bagdure ,
William Blackwelder ,
Brady S Moffett ,
Adrian Holloway ,
Vladimir Mishcherkin  and
Adnan Bhutta
Cortney B. Foster*
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Antonio G. Cabrera
Affiliation:
Department of Pediatrics, Lillie Abercrombie Section of Pediatric Cardiology and Section of Critical Care, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
Dayanand Bagdure
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
William Blackwelder
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Brady S Moffett
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, TX, USA
Adrian Holloway
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Vladimir Mishcherkin
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Adnan Bhutta
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
*
Author for correspondence: C. B. Foster, DO, Assistant Professor of Pediatrics, Associate Fellowship Director, Pediatric Critical Care, Department of Pediatrics, University of Maryland School of Medicine, 110 S Paca St, 8th Floor, Baltimore, MD 21202, USA. Tel: +1 410 328 6957; Fax: +1 410 328 0680; E-mail: [email protected]
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Abstract

Background:

Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.

Methods:

We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.

Results:

Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.

Conclusions:

Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

Keywords

Cardiaccongenital heart diseasediaphragmpediatricsurgery
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 62 - 65
Copyright
© Cambridge University Press 2019

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Footnotes

*Meeting Presentation: Abstract presentation was done at the 8th World Congress of the World Federation on Pediatric Intensive and Critical Care Societies in Toronto, Canada on 4–8 June, 2016.

References

Talwar, S, Agarwala, S, Mittal, CM, Choudhary, SK, Airan, B.Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart. Ann Pediatr Cardiol 2010; 3: 50–57.CrossRefGoogle ScholarPubMed
El Tantawy, AE, Imam, S, Shawky, H, Salah, T.Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management. World J Pediatr Congenit Heart Surg 2013; 4: 19–23.CrossRefGoogle ScholarPubMed
Joho-Arreola, AL, Bauersfeld, U, Stauffer, UG, Baenziger, O, Bernet, V.Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg 2005; 27: 53–57.CrossRefGoogle ScholarPubMed
Simansky, DA, Paley, M, Refaely, Y, Yellin, A.Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients. Thorax 2002; 57: 613–616.CrossRefGoogle ScholarPubMed
Tonz, M, von Segesser, LK, Mihaljevic, T, Arbenz, U, Stauffer, UG, Turina, MI.Clinical implications of phrenic nerve injury after pediatric cardiac surgery. J Pediatr Surg 1996; 31: 1265–1267.CrossRefGoogle ScholarPubMed
Akay, TH, Ozkan, S, Gultekin, B, et al. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int 2006; 22: 341–346.CrossRefGoogle ScholarPubMed
Akhavan, A, Merguerian, PA, Larison, C, Goldin, AB, Shnorhavorian, M.Trends in the rates of pediatric pyeloplasty for ureteropelvic junction obstruction over 19 years: a PHIS database study. Adv Urol 2014; 2014: 142625.CrossRefGoogle Scholar
Bagdure, D, Custer, JW, Rao, S, et al. Hospitalized children with encephalitis in the United States: a pediatric health information system database study. Pediatr Neurol 2016; 61: 58–62.CrossRefGoogle ScholarPubMed
Floh, AA, Zafurallah, I, MacDonald, C, Honjo, O, Fan, CS, Laussen, PC.The advantage of early plication in children diagnosed with diaphragm paresis. J Thorac Cardiovasc Surg 2017; 154: 1715–1721.CrossRefGoogle ScholarPubMed
Georgiev, S, Konstantinov, G, Latcheva, A, Mitev, P, Mitev, I, Lazarov, S.Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial? Eur J Cardiothorac Surg 2013; 44: 808–812.CrossRefGoogle ScholarPubMed
Johnson, EA, Zubair, MM, Armsby, LR, et al. Surgical quality predicts length of stay in patients with congenital heart disease. Pediatr Cardiol 2016; 37: 593–600.CrossRefGoogle ScholarPubMed