Length of stay after infant heart surgery is related to cognitive outcome at age 8 years.
OBJECTIVE
To test the hypothesis that postoperative length of stay (LOS) after infant heart surgery might be an easily measured surrogate marker for various events that culminate in later adverse cognitive outcome.


METHODS
Among 160 eligible patients with D-transposition of the great arteries undergoing reparative surgery in infancy, 155 (97%) were reevaluated at age 8 years with IQ and achievement testing. We explored whether LOS quartiles were associated with these outcomes when adjusting for perioperative and sociodemographic variables.


RESULTS
Longer cardiac intensive care unit (CICU) LOS quartiles were associated at age 8 years with lower full-scale IQ (P=.02), lower verbal IQ (P=.02), and with tendencies toward lower performance IQ (P=.08) and math achievement (P=.08) in adjusted models. Compared with patients in the first quartile of CICU LOS, those in the fourth quartile had mean scores for full-scale IQ that were lower by 7.2 points (P=.01); verbal IQ, 7.3 points (P=.02); performance IQ, 5.8 points (P=.05); and math achievement, 6.0 points (P=.07). Analyses on hospital LOS quartile were similar.


CONCLUSIONS
Longer postoperative LOS is associated with worse later cognitive function, even when adjusted for perioperative events, perfusion times, and sociodemographic variables. Further research is necessary to determine the mechanisms underlying this relation.
Newburger
Jane W
JW
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. Jane.Newburger@tch.harvard.edu
Wypij
David
D
Bellinger
David C
DC
du Plessis
Adre J
AJ
Kuban
Karl C K
KC
Rappaport
Leonard A
LA
Almirall
Daniel
D
Wessel
David L
DL
Jonas
Richard A
RA
Wernovsky
Gil
G
D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000534:rehabilitation / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D014188:Transposition of Great Vessels; D014888:Wechsler Scales