Prospective evaluation of acute neurological events after paediatric cardiac surgery

• Published in: Cardiology in the young Vol. 34; no. 7; p. 1535
• Main Authors: Frost, Olivia, Ridout, Deborah, Rodrigues, Warren, Wellman, Paul, Cassidy, Jane, Tsang, Victor T, Dorobantu, Dan, Stoica, Serban C, Hoskote, Aparna, Brown, Katherine L
• Format: Journal Article
• Language: English
• Published: England 01-07-2024
• Subjects: Cardiac Surgical Procedures - adverse effects; Child; Child, Preschool; Female; Heart Defects, Congenital - surgery; Humans; Incidence; Infant; Infant, Newborn; Length of Stay - statistics & numerical data; Male; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Risk Factors; United Kingdom - epidemiology; United Kingdom; paediatric neurology; post-operative outcomes; Cardiac surgery; paediatric cardiology; CHD
• ISSN: 1467-1107
• DOI: 10.1017/S1047951124000167

Children with CHD are at heightened risk of neurodevelopmental problems; however, the contribution of acute neurological events specifically linked to the perioperative period is unclear.
This secondary analysis aimed to quantify the incidence of acute neurological events in a UK paediatric cardiac surgery population, identify risk factors, and assess how acute neurological events impacted the early post-operative pathway.
Post-operative data were collected prospectively on 3090 consecutive cardiac surgeries between October 2015 and June 2017 in 5 centres. The primary outcome of analysis was acute neurological event, with secondary outcomes of 6-month survival and post-operative length of stay. Patient and procedure-related variables were described, and risk factors were statistically explored with logistic regression.
Incidence of acute neurological events after paediatric cardiac surgery in our population occurred in 66 of 3090 (2.1%) consecutive cardiac operations. 52 events occurred with other morbidities including renal failure (21), re-operation (20), cardiac arrest (20), and extracorporeal life support (18). Independent risk factors for occurrence of acute neurological events were CHD complexity 1.9 (1.1-3.2), p = 0.025, longer operation times 2.7 (1.6-4.8), p < 0.0001, and urgent surgery 3.4 (1.8-6.3), p < 0.0001. Unadjusted comparison found that acute neurological event was linked to prolonged post-operative hospital stay (median 35 versus 9 days) and poorer 6-month survival (OR 13.0, 95% CI 7.2-23.8).
Ascertainment of acute neurological events relates to local measurement policies and was rare in our population. The occurrence of acute neurological events remains a suitable post-operative metric to follow for quality assurance purposes.