Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database.
OBJECTIVE
There is limited information regarding the true incidence of and risk factors for chylothorax after pediatric cardiac surgery. The objective of this study was to determine, from a large multi-institution database, incidence, associated factors, and treatment strategy in patients undergoing pediatric cardiac surgery.


METHODS
All patients younger than 18 years in the Pediatric Health Information System (PHIS) database who underwent congenital heart surgery or heart transplant from 2004 to 2011 were included. Procedure complexity was assessed by Risk Adjustment for Congenital Heart Surgery-1.


RESULTS
In all, 77,777 patients (55% male) of median age 6.7 months were included. Overall incidence of chylothorax was 2.8% (n = 2205), significantly associated with increased procedure complexity, younger age, genetic syndromes, vein thrombosis, and higher annual hospital volume. Patients with multiple congenital procedures had the highest incidence. Incidence increased with time, from 2% in 2004 to 3.7% in 2011 (P < .0001). Chylothorax was associated with longer stay (P < .0001), increased adjusted risk for in-hospital mortality (odds ratio, 2.13; 95% confidence interval, 1.75-2.61), and higher cost (P < .0001), regardless of procedure complexity. Of all patients with chylothorax, 196 (8.9%) underwent thoracic duct ligation or pleurodesis a median of 18 days after surgery. Total parenteral nutrition, medium-chain fatty acid supplementation, and octreotide were used in 56%, 1.7%, and 16% of patients, respectively.


CONCLUSIONS
Chylothorax is a significant problem in pediatric cardiac surgery and is associated with increased mortality, cost, and length of stay. Strategies should be developed to improve prevention and treatment.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex. Electronic address: cmmery@texaschildrens.org.
Carlos M
CM
Mery
Department of Pharmacy, Texas Children's Hospital, Houston, Tex; Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
Brady S
BS
Moffett
The Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
Muhammad S
MS
Khan
Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Wei
W
Zhang
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Francisco A
FA
Guzmán-Pruneda
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Charles D
CD
Fraser
Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
Antonio G
AG
Cabrera
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005227:Fatty Acids / Q000008:administration & dosage; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008026:Ligation; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015282:Octreotide / Q000627:therapeutic use; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total; D018700:Pleurodesis; D012189:Retrospective Studies; D012307:Risk Factors; D013897:Thoracic Duct / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D005227:Fatty Acids; D015282:Octreotide
20; 41.1; 41.2; CI; ICD-9-CM; IQR; International Classification of Diseases, Ninth Revision, Clinical Modification; MCT; OR; PHIS; Pediatric Health Information System; RACHS; Risk Adjustment for Congenital Heart Surgery-1; TPN; confidence interval; interquartile range; medium-chain triglycerides; odds ratio; total parenteral nutrition