Abstract 1903: Corticosteroids Are Associated With Increased Morbidity in Children Undergoing Congenital Heart Surgery
Background: Children undergoing congenital heart surgery often receive corticosteroids (CS) with the aim of reducing post-operative inflammation and capillary leak following cardiopulmonary bypass; however outcomes associated with this approach are unclear. We evaluated outcomes associated with CS use in a large multicenter cohort undergoing congenital heart surgery.
Methods: The Pediatric Health Information Systems Database was used to evaluate CS use (prior to or during surgery) in children (0 –18y) undergoing congenital heart surgery at 38 US children’s hospitals from 2003–2008. Propensity scores were constructed to account for potential confounding including age, sex, race, prematurity, genetic syndrome, type of surgery [using the Risk Adjustment in Congenital Heart Surgery (RACHS) method], center, and center volume. Multivariable analysis, adjusting for propensity score, individual covariates, and within center clustering was performed to evaluate in-hospital mortality and post-operative morbidity including length of stay (LOS), duration of ventilation, and infection (sepsis, wound infection, mediastinitis).
Results: A total of 46,730 patients were included: 55% male, median age 8m [interquartile range (IQR) 2m-4y]. Overall, 54% of patients received CS (range 1–96% of patients/center). CS use was associated with younger age, genetic syndrome, higher RACHS category, and smaller center volume. Unadjusted in-hospital mortality was 3.5%, median LOS 7d (IQR 4 –16d), post-operative infection rate 2.9%, and median duration of ventilation 4d (IQR 2–7d). In multivariable analysis, there was no difference in mortality (adjusted OR 1.13, 95% CI 0.98 –1.30, p=NS). CS use was associated with longer LOS (+2.2d, 95% CI 1.6 –2.7d, p<0.0001), greater infection (adjusted OR 1.3, 95% CI 1.1–1.5, p<0.001), and no difference in duration of ventilation (+0.2d, 95% CI −0.2– 0.6d, p=NS).
Conclusions: Use of CS in children undergoing congenital heart surgery varies widely. CS use did not impact postoperative mortality and was associated with longer LOS and higher rates of infection. These observational data call into question the role of CS in children undergoing congenital heart surgery and indicate the need for a clinical trial in this population.