title: Preoperative Determinants of Outcomes of Infant Heart Surgery in a Limited-Resource Setting.
abstract: We studied the effect of preoperative determinants on early outcomes of 1028 consecutive infant heart operations in a limited-resource setting. Comprehensive data on pediatric heart surgery (January 2010-December 2012) were collected prospectively. Outcome measures included in-hospital mortality, prolonged ventilation (>48 hours), and bloodstream infection (BSI) after surgery. Preoperative variables that showed significant individual association with outcome measures were entered into a logistic regression model. Weight at birth was low in 224 infants (21.8%), and failure to thrive was common (mean-weight Z score at surgery was 2.72 ± 1.7). Preoperatively, 525 infants (51%) needed intensive care, 69 infants (6.7%) were ventilated, and 80 infants (7.8%) had BSI. In-hospital mortality (4.1%) was significantly associated with risk adjustment for congenital heart surgery-1 (RACHS-1) risk category (P < 0.001). Neonatal status, preoperative BSI, and requirement of preoperative intensive care and ventilation had significant individual association with adverse outcomes, whereas low birth weight, prematurity, and severe failure to thrive (weight Z score <-3) were not associated with adverse outcomes. On multivariable logistic regression analysis, preoperative sepsis (odds ratio = 2.86; 95% CI: 1.32-6.21; P = 0.008) was associated with mortality. Preoperative intensive care unit stay, ventilation, BSI, and RACHS-1 category were associated with prolonged postoperative ventilation and postoperative sepsis. Neonatal age group was additionally associated with postoperative sepsis. Although severe failure to thrive was common, it did not adversely affect outcomes. In conclusions, preoperative BSI, preoperative intensive care, and mechanical ventilation are strongly associated with adverse outcomes after infant cardiac surgery in this large single-center experience from a developing country. Failure to thrive and low birth weight do not appear to adversely affect surgical outcomes.
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: N Srinath
authors.initials: NS
authors.lastname: Reddy
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India. Electronic address: maheshpeds@yahoo.co.in.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kappanayil
authors.affiliation: Department of Cardiac Anesthesiology-Critical Care, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Balachandran
authors.affiliation: Department of Cardiology, Boston Children׳s Hospital, Boston, Massachusetts.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: Abish
authors.initials: A
authors.lastname: Sudhakar
authors.affiliation: Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: G S
authors.initials: GS
authors.lastname: Sunil
authors.affiliation: Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: R Benedict
authors.initials: RB
authors.lastname: Raj
authors.affiliation: Department of Cardiac Anesthesiology-Critical Care, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Kumar
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: bloodstream infection; congenital heart surgery; limited resources; preoperative risk factors