Characteristics and risk factors for postoperative mortality in children with congenital heart disease (CHD): a retrospective cross-sectional study

Author:

Liu Guangjian1,Guo Yuxiong2,Pan Liyan1,Chen Peiling2,Huang Zijian2,Zhang Lei2,Wu Jiaxing2,Cai Yuanbin2,Chen Chunling2,Zhang Jingwen2,Sun Yueyu2,Zhou Chengbin3,Yuan Haiyun3,Liu Xiaobing3,Cen Jianzheng3,Wen Shusheng3,Zheng Guilang2

Affiliation:

1. Guangdong Provincial People's Hospital

2. Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University,Guangzhou

3. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University

Abstract

Abstract Objectives:We performed a retrospective cross-sectional study to determine the characteristics and risk factors for postoperative mortality in children who underwent CHD surgery. Design: A cross-sectional retrospective study. Setting: Guangdong Provincial People’s Hospital from January 1, 2005, to December 31, 2020. Patients:All pediatric patients who underwent open heart surgery for CHD. Interventions: None. Measurements and Main Results: Patients’ demographic features, clinical data, preoperative comorbidities and postoperative complications, and outcomes were collected. The in-hospital mortality rate was computed, and the relationship with independent variables was determined. Univariate and multivariate logistic regression analyses were used to determine risk factors for in-hospital mortality in children with CHD surgery. A total of 23,366 children with CHD were included in the analysis, of whom 502 patients (2.15%) died after CHD surgery. Complex mixed defect CHD, neonatal period and male sex were the CHD type, age group and sex with the highest in-hospital mortality of 4.56%, 11.85% and 2.55%, respectively. Male (OR=1.31; 95% CI 1.04 to 1.65; p=0.006), infant period (OR=0.55; 95% CI 0.42 to 0.71; p<0.001), toddler age (OR=0.37; 95% CI 0.25 to 0.56; p<0.001), preschool age (OR=0.31; 95% CI 0.19 to 0.50; p<0.001), school age and adolescence (OR=0.37; 95% CI 0.23 to 0.61; p<0.001), left obstructive lesion CHD (OR=2.13; 95% CI 1.43 to 3.17; p=0.014), right to left shunt CHD (OR=3.21; 95% CI 2.39 to 4.30; p<0.001), complex mixed defect CHD (OR=2.34; 95% CI 1.80 to 3.06; p<0.001), critical case at admission (OR=2.44; 95% CI 1.90 to 3.12; p<0.001), number of rescues, postoperative infection and respiratory failure were independently associated with in-hospital mortality. Conclusions: The younger the age and the more complicated the cyanotic heart disease, the higher the mortality rate, especially for boys. A critical condition at admission and postoperative infection especially in the respiratory system, increased in-hospital mortality. Further studies are needed paying more attention to preoperative condition maintenance and postoperative complication control.

Publisher

Research Square Platform LLC

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