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Congenital cardiac surgical complications of the integument, vascular system, vascular-line(s), and wounds: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

Henry L. Walters III ,
Howard E. Jeffries ,
Gordon A. Cohen  and
Thomas Klitzner
Henry L. Walters III*
Affiliation:
Department of Cardiovascular Surgery, Children’s Hospital of Michigan, and Wayne State University School of Medicine, Detroit, Michigan
Howard E. Jeffries
Affiliation:
Quality Improvement for Critical Care Services, Children’s Hospital and Regional Medical Center, Division of Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington
Gordon A. Cohen
Affiliation:
Division of Cardiothoracic Surgery, Children’s Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington
Thomas Klitzner
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of California at Los Angeles School of Medicine, Los Angeles, California, United States of America
*
Correspondence to: Henry L. Walters III, MD, Department of Cardiovascular Surgery, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. Tel: 313 745 5538; Fax: 313 993 0531; E-mail: [email protected]
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Abstract

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to a collection of loosely related topics that include the following groups of complications: 1) Complications of the Integument, 2) Complications of the Vascular System, 3) Complications of the Vascular-Line(s), 4) Complications of Wounds. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Keywords

Congenital heart diseasequality improvementpatient safetyoutcomesregistryoperative morbiditypaediatricsurgerycongenital abnormalitiescardiac surgical proceduresheartcatheterskinarteryvein
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S2: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease , December 2008 , pp. 245 - 255
Copyright
Copyright © Cambridge University Press 2008

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References

1.McLane, KM, Bookout, K, McCord, S, McCain, J, Jefferson, LS. The 2003 national pediatric pressure ulcer and skin breakdown prevalence study. J Wound Ostomy Continence Nurs 2004; 31: 168–178.CrossRefGoogle Scholar
2.Russell, MJ, Gaetz, M. Intraoperative electrode burns. J Clin Monit Comput 2004; 18: 25–32.CrossRefGoogle ScholarPubMed
3.Lee, TW, Chen, TM, Cheng, TY, et al. Skin injury in the operating room. Injury 1998; 29: 345–347.CrossRefGoogle ScholarPubMed
4.Nahlieli, O, Baruchin, AM, Levi, D, Shapira, Y, Yoffe, B. Povidone-Iodine related burns. Burns 2001; 27: 185–188.CrossRefGoogle ScholarPubMed
5.Demir, E, O’Dey, DM, Pallua, N. Accidental burns during surgery. J Burn Care & Res 2006; 27: 895–900.CrossRefGoogle ScholarPubMed
6.National Pressure Ulcer Advisory Panel: Pressure ulcer prevalence, cost and risk assessment: Consensus development conference statement. Decubitus 1989; 2: 24–28.Google Scholar
7.Jiricka, MK, Ryan, P, Carvalho, MA, Buckvich, J. Pressure ulcer risk factors in an ICU population. Am J Crit Care 1995; 4: 361–367.CrossRefGoogle Scholar
8.Quigley, SM, Curley, MAQ. Skin integrity in the pediatric population: Preventing and managing pressure ulcers. J Soc Pediatr Nurs 1996; 1: 7–18.CrossRefGoogle ScholarPubMed
9.Zollo, MB, Gotisha, ML, Berens, RJ, Schmidt, JE, Weigle, CG. Altered skin integrity in children admitted to a pediatric intensive care unit. J Nurs Care Qual 1996; 11: 62–67.CrossRefGoogle ScholarPubMed
10.Allman, RM, Goode, PS, Burst, N, Bartolucci, AA, Thomas, DR. Pressure ulcers, hospital complications and disease severity: Impact on hospital costs and length of stay. Adv Wound Care 1999; 12: 22–30.Google ScholarPubMed
11.EscherNeidig, JR, Kleiber, C, Oppliger, RA. Risk factors associated with pressure ulcers in the pediatric patient following open-heart surgery. Progr Cardiovasc Nurs 1989; 4: 99–106.Google Scholar
12.Curley, MAQ, Quigley, AM, Lin, M. Pressure ulcers in pediatric intensive care: Incidence and associated factors. Pediatr Crit Care Med 2003; 4: 284–290.CrossRefGoogle ScholarPubMed
13.Curley, MAQ, Razmus, IS, Roberts, KE, Wypij, D. Predicting pressure ulcer risk in pediatric patients: The Braden Q. Nurs Res 2003; 52: 22–33.CrossRefGoogle Scholar
14.Huffines, B, Logsdon, MC. The neonatal skin risk assessment scale for predicting skin breakdown in neonates. Issues Compr Pediatr Nurs 1997; 20: 103–114.CrossRefGoogle ScholarPubMed
15.Bergstrom, N, Allman, RM, Alvarez, OM, et al. Treatment of pressure ulcers: Clinical practice guideline. No. 15 AHCPR Pub 95-0652. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville, MD, 1994.Google Scholar
16.Scheer, BV, Perel, A, Pfeiffer, UJ. Clinical review: Complications and risk factors of peripheral arterial catheters used for hemodynamic monitoring in anesthesia and intensive care medicine. Crit Care 2002; 6: 198–204.CrossRefGoogle Scholar
17.Kahler, AC, Mirza, F. Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients. Pediatr Crit Care Med 2002; 3: 370–374.CrossRefGoogle ScholarPubMed
18.Fikar, CR, Koch, S. Etologic factors of acute aortic dissection in children and young adults. Clin Pediatr 2000; 39: 71–80.CrossRefGoogle Scholar
19.Daily, PO, Trueblood, HW, Stinson, EB, Wuerflein, RD, Shumway, NE. Management of acute aortic dissections. Ann Thorac Surg 1970; 10: 237–247.CrossRefGoogle ScholarPubMed
20.DeBakey, ME, Henly, WS, Cooley, DA, Morris, GC, Crawford, ES, Beall, AC. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965; 49: 130–149.CrossRefGoogle ScholarPubMed
21.Khan, AM, Jacobs, S. Trash feet after coronary angiography. Heart 2003; 89: 17–18.CrossRefGoogle ScholarPubMed
22.Om, A, Ellham, S, DiSciasco, G. Cholesterol embolization: An underdiagnosed clinical entity. Am Heart J 1992; 124: 1321–1326.CrossRefGoogle ScholarPubMed
23.Beck, C, Dubois, J, Grignon, A, Lacroix, J, David, M. Incidence and risk factors of catheter-related deep vein thrombosis in pediatric intensive care unit: a prospective study. J Pediatr 1998; 133L: 237–241.CrossRefGoogle Scholar
24.Journeycake, JM, Buchanan, GR. Thrombotic complications of central venous catheters in children. Curr Opin Hematol 2003; 10: 369–374.CrossRefGoogle ScholarPubMed
25.Hausler, M, Hubner, D, Delhaas, T, Muhler, EG. Long term complications of inferior vena cava thrombosis. Arch Dis Child 2001; 85: 228–233.CrossRefGoogle ScholarPubMed
26.Shefler, A, Gillis, J, Lam, A, O’Connell, AJ, Lammi, A. Inferior vena cava thrombosis as a complication of femoral vein catheterization. Arch Dis Child 1995; 72: 343–345.CrossRefGoogle Scholar
27.Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001; 32: 1249–1272.CrossRefGoogle ScholarPubMed
28.O’Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002; 51: 1–26.Google ScholarPubMed
29.Olbrecht, VA, Barreiro, CJ, Bonde, PN, et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg 2006; 82: 902–908.CrossRefGoogle ScholarPubMed
30.Robicsek, F, Fokin, A, Cook, J, Bhatia, D. Sternal instability after midline sternotomy. J Thorac Cardiovasc Surg 2000; 48: 1–8.CrossRefGoogle ScholarPubMed
31.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20: 247–278.CrossRefGoogle ScholarPubMed
32.Allpress, AL, Rosenthal, GL, Goodrich, KM, Lupinetti, FM, Zerr, DM. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J 2004; 23: 231–234.CrossRefGoogle ScholarPubMed
33.Tortoriello, TA, Friedman, JD, Mckenzie, ED, et al. Mediastinitis after pediatric cardiac surgery: A 15-year experience at a single institution. Ann Thorac Surg 2003; 76: 1655–1660.CrossRefGoogle ScholarPubMed
34.Long, CB, Shah, SS, Lautenbach, E, et al. Postoperative mediastinitis in children: Epidemiology, microbiology and risk factors for gram-negative pathogens. Pediatr Infect Dis J 2005; 24: 315–319.CrossRefGoogle ScholarPubMed
35.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG (ed.). Hospital Epidemiology and Infection Control, 3rd ed.Lippincott Williams & Wilkins, Philadelphia, 2004, pp 1659–1702.Google Scholar