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Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

Published online by Cambridge University Press:  03 September 2020

Igor V. Polivenok ,
William M. Novick Open the ORCID record for William M. Novick [Opens in a new window] ,
Aleksander V. Pyetkov  and
Marcelo Cardarelli
Igor V. Polivenok
Affiliation:
Zaitcev V.T. Institute of General and Urgent Surgery, Kharkiv, Ukraine William Novick Global Cardiac Alliance, Memphis, TN, USA
William M. Novick*
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA University of Tennessee Health Science Center - Global Surgery Institute, Memphis, TN, USA
Aleksander V. Pyetkov
Affiliation:
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Marcelo Cardarelli
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA Pediatric Cardiac Surgery, Inova Children’s Hospital, Fairfax, VA, USA
*
Author for correspondence: W. M. Novick, MD, 1750 Madison Ave., Suite 500, Memphis, TN38104, USA. Tel: +1-901-438-9413. E-mail: [email protected]
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Abstract

Background:

The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.

Aim:

To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.

Methods:

Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.

Results:

Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).

Conclusions:

In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

Keywords

Paediatric cardiac surgerypost-operative carecomplicationsCHD
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1659 - 1665
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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