Abstract 12036: Long-Term Outcome of Children Requiring Prolonged Intensive Care After Cardiac Surgery: Melbourne Experience
Introduction: The number of children who require prolonged ( 28days) intensive care unit (ICU) stay after cardiac surgery has increased in the last decade. Previous studies have identified risk factors for long-stay after paediatric cardiac surgery. However, there are no studies which report long-term outcome in this group.
Methods: From 1997 to 2011, 115 children required prolonged ICU stay after cardiac surgery.Information was collected retrospectively. Functional outcome was assessed using modified Glasgow outcome scale.
Results: 90 %(n=104) were ≤1 year of age and 61(53%) had univentricular physiology. Median (IQR) ICU length of stay(LOS) was 38(32 - 55)days, hospital LOS 68(48-104)days and duration of mechanical ventilation 37(30-53)days. Forty-five (39%) received mechanical circulatory support. Overall survival at ICU discharge was 74% (95%CI 64.8-81.6), at 1 year 55.6% (95%CI 46.1-64.1) and at 5 years 51.4% (41.8-60.2). By multivariable analysis, the only predictors of overall mortality were single ventricle physiology [OR 4.0, 95%CI 1.6-10.1] and multi-organ failure(OR 9.4, 95% CI 3.2-27.7), while era did not influence mortality: 1997-2004 Vs. 2005-2011(log-rank p=0.64). Additional risk factor for mortality during ICU stay was nosocomial bacteremia (OR 5.6, 95%CI 1.4-21.8). Among children who survived (n=58), long-term functional outcome(median 2.7 years) was favorable (normal, functionally normal, mild disability) in 32(55%), unfavorable (moderate or severe disability) in 21(36%) and unknown in 5(9%).
Conclusion: Long-term outcome for most children requiring prolonged intensive care after cardiac surgery is poor, especially in children with single ventricle physiology: more than half of them do not survive and among survivors several experience considerable morbidity.
- © 2013 by American Heart Association, Inc.