Adults undergoing cardiac surgery at a children's hospital: an analysis of perioperative morbidity.
BACKGROUND
Limited data exist regarding the perioperative morbidity profile of adults who have cardiac operations at pediatric facilities.


METHODS
A retrospective review (January 2000 to December 2004) of patients (aged 18 years or older) who underwent cardiac surgery at our pediatric institution was performed.


RESULTS
There were 149 cardiac operations performed in 135 patients. There were 2 early deaths. There were 70 preoperative noncardiac morbidities in 49 patients (36%) and 140 preoperative cardiac morbidities in 78 patients (58%). Preoperative arrhythmia (n = 76) and moderate or greater ventricular systolic dysfunction (n = 24) were most common. There were 51 postoperative adverse noncardiac events in 32 patients (24%). Renal insufficiency (> 0.5 mg/dL baseline change; n = 8) was most common. There were 53 postoperative adverse cardiac events in 44 patients (33%). Ventricular tachycardia (n = 13) was most common. Risk factors for postoperative adverse noncardiac events included preoperative histories of New York Heart Association (NYHA) class III or greater (p < 0.001), seizure (p = 0.04), and psychiatric disorder (p = 0.002). Risk factors for postoperative adverse cardiac events included older patient age (p = 0.001), preoperative functional single ventricle (p = 0.006), NHYA class III or greater (p = 0.003), atrial fibrillation/flutter (p < 0.001), and ventricular tachycardia or fibrillation (p = 0.04).


CONCLUSIONS
Postoperative adverse events occur frequently when adults undergo cardiac operations at children's hospitals. Older patient age, preoperative arrhythmias, and preoperative NHYA class are predictors of postoperative adverse cardiac events.
Rossano
Joseph W
JW
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA. jrossano@bcm.tmc.edu
Smith
E O'Brian
EO
Fraser
Charles D
CD
McKenzie
E Dean
ED
Chang
Anthony C
AC
Hemingway
Amy
A
Price
Jack F
JF
Dickerson
Heather A
HA
Mott
Antonio R
AR
D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications; D012720:Severity of Illness Index