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Chylothorax following paediatric cardiac surgery: a case–control study

Published online by Cambridge University Press:  24 August 2017

Thomas G. Day Open the ORCID record for Thomas G. Day [Opens in a new window] ,
Diana Zannino ,
Daniel Golshevsky ,
Yves d’Udekem ,
Christian Brizard  and
Michael M. H. Cheung
Thomas G. Day*
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
Diana Zannino
Affiliation:
Heart Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
Daniel Golshevsky
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
Yves d’Udekem
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia
Christian Brizard
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia
Michael M. H. Cheung
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia Heart Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
*
Correspondence to: T. G. Day, Department of Cardiology, Royal Children’s Hospital, Parkville, VIC, Australia. Tel: 02074059200; Fax: 02078298673; E-mail: [email protected]
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Abstract

Objectives

The aims of this study were to investigate risk factors for the development of postoperative chylothorax following paediatric congenital heart surgery and to investigate the impact of a management guideline on management strategies and patient outcome.

Methods

All patients with chylothorax following cardiac surgery at the Royal Children’s Hospital, Melbourne, over a 48-month period beginning in January 2008 were identified. A control group, matched for age, date of surgery, and sex, was identified. To investigate potential risk factors, univariable and multivariable logistic regression models were constructed with paired analysis. To examine the effect of a standardised management protocol, data before and after the implementation of the guideline were compared.

Results

In total, 121 cases of chylothorax were identified, with 121 controls, matched for age at surgery, date of surgery, and sex. The incidence of chylothorax was 5.23%. Increasing surgical complexity (univariable OR 0.17 for the least complex versus the most complex group, p=0.02), closed-heart surgeries (OR 0.07 for open versus closed, p<0.001), and redo chest incisions (OR 10.0 for redo versus virgin, p<0.001) were significantly associated with chylothorax. The standardised management protocol had no significant impact on either drainage duration or management strategy.

Conclusions

We have replicated the previously reported association between surgical complexity and chylothorax risk, and have shown, for the first time, that redo chest openings are also associated with a significantly increased risk. The implementation of a standardised management protocol in our institution did not result in a significant change in either chylothorax drainage duration or management strategy.

Keywords

Chylothoraxcardiac surgerypaediatrics
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 222 - 228
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Copyright
© Cambridge University Press 2017 

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Footnotes

†

Current address: Cardiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, United Kingdom.

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