Determinants of early outcome after neonatal cardiac surgery in a developing country

Bakshi, Kinjal D; Vaidyanathan, Balu; Sundaram, K. R.; Roth, Stephen J.; Shivaprakasha, Krishnanaik; Rao, Suresh; Nair, Suresh; Chengode, Suresh; Kumar, Raman Krishna

doi:10.1016/j.jtcvs.2007.04.042

Cited by 40 publications

(46 citation statements)

References 26 publications

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“…We selected candidate variables based on risk factors for infection after cardiac surgery previously identified [1, 3-5, 7-9, 17, 22-25] as well as potential risk factors based on clinical suspicion of the authors (including pediatric cardiologists, cardiovascular surgeons, and an infectious disease specialist). We included only risk factors identified prior to the operation.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiopulmonary bypass, reintubation, and surgical site infection increase the risk of bloodstream infection [22]. Risk factors for surgical site infection include undergoing >1 cardiothoracic procedure, preoperative infection, surgery on a Monday, higher American Society of Anesthesiologists (ASA) score, higher Pediatric Risk of Mortality (PRISM) score, peri-operative hypothermia, open chest after surgery, need for re-exploration, nasal colonization with Staphylococcus aureus , longer duration of surgery, longer pre-operative stay, and younger age [4, 5, 7-9, 17, 23, 24].…”

Section: Commentmentioning

confidence: 99%

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Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Barker¹,

O’Brien²,

Welke³

et al. 2010

The Annals of Thoracic Surgery

119

106

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Background In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population. Methods Using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we created a multivariable model in which the primary outcome was major infection (septicemia, mediastinitis, or endocarditis). Candidate independent variables included demographic characteristics, comorbid conditions, preoperative factors, and cardiac surgical procedures. We created a reduced model by backward selection and then created an integer scoring system using a scaling factor with scores corresponding to percent risk of infection. Results Of 30,078 children from 48 centers, 2.8% had major infection (2.6% septicemia, 0.3% mediastinitis, and 0.09% endocarditis). Mortality and postoperative length of stay were greater in those with major infection (mortality: 22.2% vs. 3.0%; length of stay > 21 days: 69.9% vs. 10.7%). Young age, high complexity, previous cardiothoracic operation, preoperative length of stay >1 day, preoperative ventilator support, and presence of a genetic abnormality were associated with major infection after backward selection (p<0.001). Estimated infection risk ranged from <0.1% to 13.3%; the model discrimination was good (c-index 0.79). Conclusions We created a simple bedside tool to identify children at high risk for major infection after cardiac surgery. These patients may be targeted for interventions to reduce the risk of infection and for inclusion in future clinical trials.

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Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Barker¹,

O’Brien²,

Welke³

et al. 2010

The Annals of Thoracic Surgery

119

106

View full text Add to dashboard Cite

show abstract

“…The outcomes after paediatric cardiac surgery in infants and newborns are critically dependent on the skills and cohesiveness of the individual team members and there is a fairly steep learning curve for the institution 33. Newly established programmes therefore often need to have careful case selection policies in the beginning.…”

Section: Development Of Paediatric Cardiology and Paediatric Cardiac mentioning

confidence: 99%

“…Economic considerations (below) also impact treatment practices significantly. A number of important publications, mostly from selected Indian institutions with paediatric heart programmes, highlight the unique problems encountered in India and suggest solutions to deal with them 33 – 45…”

Section: Development Of Paediatric Cardiology and Paediatric Cardiac mentioning

confidence: 99%

Paediatric heart care in India

Kumar

Shrivastava

2008

Heart

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There have been few systematic efforts to define the burden of paediatric heart disease in India. Estimates based on published studies on congenital heart disease (CHD) at birth suggest a massive CHD burden. Absolute numbers of children with other heart diseases are also likely to be substantial. Given the enormity of the problem the number of paediatric heart programmes and specially trained paediatric cardiologists and paediatric cardiac surgeons are woefully inadequate. They are largely clustered in those parts of India that are experiencing improving economy and human development. For the average family the cost of care of a child with heart disease is prohibitive because care of children with heart disease often requires considerable human and material resources, together with sophisticated technology. While paediatric cardiology is only now being recognised in India as a major specialty, there is a need to intensify efforts to develop the specialty especially in those parts of India where there are very few centres. The present challenges are many and they include obtaining representative data on disease burden, establishing quality institutions with comprehensive paediatric cardiac programme training a cadre of professionals for paediatric heart care, developing cost-effective management strategies and improving awareness on diagnosis and management of paediatric heart diseases.

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“…Newborn heart operations are performed in steadily increasing numbers with gratifying early postoperative outcomes. [1] The growth of catheter interventions has been even more impressive in terms of numbers and procedural outcome. Many innovations in technique are now being reported from centers in emerging economies.…”

Section: What Are the Considerations That Influence How We Make Decismentioning

confidence: 99%

Distilling wisdom from our collective experience

Kumar

2014

Ann Pediatr Card

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Determinants of early outcome after neonatal cardiac surgery in a developing country

Cited by 40 publications

References 26 publications

Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Paediatric heart care in India

Distilling wisdom from our collective experience

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