title: Down syndrome and postoperative complications after paediatric cardiac surgery: a propensity-matched analysis.
abstract: OBJECTIVE
  The incidence of congenital heart disease is ~50%, mostly related to endocardial cushion defects. The aim of our study was to investigate the postoperative complications that occur after paediatric cardiac surgery.
  
  
  METHODS
  Our perioperative data were analysed in paediatric patients with Down syndrome undergoing cardiac surgery. We retrospectively analysed the data from 2063 consecutive paediatric patients between January 2003 and December 2008. After excluding the patients who died or had missing data, the analysed database (before propensity matching) contained 129 Down patients and 1667 non-Down patients. After propensity matching, the study population comprised 222 patients and 111 patients had Down syndrome.
  
  
  RESULTS
  Before propensity matching, the occurrences of low output syndrome (21.2 vs 32.6%, P = 0.003), pulmonary complication (14 vs 28.7%, P < 0.001) and severe infection (11.9 vs 22.5%, P = 0.001) were higher in the Down group. Down patients were more likely to have prolonged mechanical ventilation [median (interquartile range) 22 (9-72) h vs 49 (24-117) h, P = 0.007]. The total intensive care unit length of stay [6.9 (4.2-12.4) days vs 8.3 (5.3-13.2) days, P = 0.04] and the total hospital length of stay [17.3 (13.3-23.2) days vs 18.3 (15.1-23.6) days, P = 0.05] of the Down patients were also longer. Mortality was similar in the two groups before (3.58 vs 3.88%, P = 0.86) and after (5.4 vs 4.5%, P = 1.00) propensity matching. After propensity matching, there was no difference in the occurrence of adverse events.
  
  
  CONCLUSIONS
  After propensity matching Down syndrome was not associated with increased mortality or complication rate following congenital cardiac surgery.
authors.affiliation: School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
authors.forename: Roland
authors.initials: R
authors.lastname: Tóth
authors.forename: Péter
authors.initials: P
authors.lastname: Szántó
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Prodán
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lex
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Sápi
authors.forename: András
authors.initials: A
authors.lastname: Szatmári
authors.forename: János
authors.initials: J
authors.lastname: Gál
authors.forename: Tamás
authors.initials: T
authors.lastname: Szántó
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D004314:Down Syndrome / Q000150:complications* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congenital heart disease; Down syndrome; Paediatric cardiac surgery; Paediatrics; Predictors