Corticosteroids and outcome in children undergoing congenital heart surgery: analysis of the Pediatric Health Information Systems database.
BACKGROUND
Children undergoing congenital heart surgery often receive corticosteroids with the aim of reducing the inflammatory response after cardiopulmonary bypass; however, the value of this approach is unclear.


RESULTS
The Pediatric Health Information Systems Database was used to evaluate outcomes associated with corticosteroids in children (0 to 18 years of age) undergoing congenital heart surgery at 38 US centers from 2003 to 2008. Propensity scores were constructed to account for potential confounders: age, sex, race, prematurity, genetic syndrome, type of surgery (Risk Adjustment in Congenital Heart Surgery [RACHS-1] category), center, and center volume. Multivariable analysis, adjusting for propensity score and individual covariates, was performed to evaluate in-hospital mortality, postoperative length of stay, duration of ventilation, infection, and use of insulin. A total of 46 730 children were included; 54% received corticosteroids. In multivariable analysis, there was no difference in mortality among corticosteroid recipients and nonrecipients (odds ratio, 1.13; 95% confidence interval, 0.98 to 1.30). Corticosteroids were associated with longer length of stay (least square mean difference, 2.18 days; 95% confidence interval, 1.62 to 2.74 days), greater infection (odds ratio, 1.27; 95% confidence interval, 1.10 to 1.46), and greater use of insulin (odds ratio, 2.45; 95% confidence interval, 2.24 to 2.67). There was no difference in duration of ventilation. In analysis stratified by RACHS-1 category, no significant benefit was seen in any group, and the association of corticosteroids with increased morbidity was most prominent in RACHS-1 categories 1 through 3.


CONCLUSIONS
In this observational analysis of children undergoing congenital heart surgery, we were unable to demonstrate a significant benefit associated with corticosteroids and found that corticosteroids may be associated with increased morbidity, particularly in lower-risk patients.
Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 27715, USA. sara.pasquali@duke.edu
Sara K
SK
Pasquali
Matthew
M
Hall
Jennifer S
JS
Li
Eric D
ED
Peterson
James
J
Jaggers
Andrew J
AJ
Lodge
Bradley S
BS
Marino
Denise M
DM
Goodman
Samir S
SS
Shah
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000305:Adrenal Cortex Hormones