title: Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals.
abstract: OBJECTIVE
  To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals.
  
  
  METHODS
  A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed.
  
  
  METHODS
  Tertiary children's hospitals in the United States.
  
  
  METHODS
  All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score.
  
  
  METHODS
  Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant.
  
  
  RESULTS
  Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group ($38,031 [IQR $31,900-$48,844] vs. ($41,896 [IQR $32,854-$56,020], P < .001). Mortality was similar between cases and controls (22% vs. 1.9%, P =.692). Surgical complications occurred similarly between cases and controls (13.5% vs. 12.4%, P = .535). Cases had longer intensive care unit length of stay than controls (3 vs. 2 days, P = .001), resulting in longer overall hospital length of stay (5 vs. 4 days, P < .001). Cases also had a higher odds of undergoing mechanical ventilation for >96 hours (OR 2.0, 95% CI 1.1-3.7) and higher rate of total parenteral nutrition use (7.2% vs. 4.5%, P = .040). Median hospital charges were higher in cases (clinical: $6,696 vs. $5,872; laboratory: $14,168 vs. $12,251; pharmacy: $12,971 vs. $10,426; imaging: $6,259 vs. $5,660; P ≤ .030 for all).
  
  
  CONCLUSIONS
  The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.
authors.affiliation: Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA. shamszadp@email.chop.edu.
authors.forename: Pirouz
authors.initials: P
authors.lastname: Shamszad
authors.affiliation: Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.affiliation: Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Lowry
authors.affiliation: Department of Pediatrics, Children's Heart Center, Division of Critical Care, Children's of Mississippi, University of Mississippi Medical Center, Jackson, Miss, USA.
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Knudson
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D063766:Pediatric Obesity / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cardiac Surgery; Complications; Diabetes Mellitus; Hospital Utilization; Obesity