Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease

Abstract

This study was undertaken to evaluate factors predictive of postoperative outcome after general surgical (GS) procedures in patients with congenital heart disease (CHD). All patients with a diagnosis of CHD who underwent a GS procedure under general anesthesia during a consecutive 10-year period were considered eligible for the study The congenital heart defect was classified as either simple (ASD, VSD, PDA) or complex (endocardial cushion defects, transposition of the great vessels, tetralogy of Fallot), and the GS procedure as either major (intraperitoneal, intrathoracic, or vascular reconstructive) or minor (inguinal herniorrhaphy, vascular access). The overall mortality rate for the patient population was 12% (27 deaths among 226 procedures), minor procedures being associated with a 3% mortality rate (2 of 70 procedures), and major procedures with a 16% mortality rate (25 of 156 procedures). Incremental risk factors for mortality included a preoperative American Society of Anesthesiologists' (ASA) physical status class of IV or higher (P = .0003), a preoperative in-hospital stay of 10 or more days (P = .004), birth at a tertiary care center (P = .04), and emergency operations (P = .05). In the subgroup of patients less than 6 months old, weight of less than 2.4 kg at the time of surgery and a 1-minute Apgar score of less than 4 were additional independent risk factors (P = .04 and .01, respectively). By logistic analysis, previous corrective cardiac procedures, whether complete or palliative, did not significantly alter the postoperative outcome. The authors conclude that physiologically well-compensated patients with CHD can undergo elective operations at a low operative risk; however, poorly compensated patients undergoing urgent or emergent operations are at high risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased Risk of General Anesthesia for High-Risk Patients Undergoing Magnetic Resonance Imaging

“…8 Our data confirm findings that the risk of anesthesia correlates with the patient's ASA status. In our calculations, patients with ASA IV versus those with ASA III status have a higher rate of anesthesia-related mortality independent of location.…”

Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease

“…Patients with CHD, especially those with complex defects, have increased perioperative morbidity 10, 11 . Additional risk factors for poor outcome in noncardiac surgery are emergencies and procedures involving the respiratory or central nervous system 6, 9– 11 .…”

Anaesthetic implications of congenital heart disease for children undergoing non-cardiac surgery

“…Previous corrective cardiac surgery, whether complete or palliative, does not significantly alter the postoperative outcome. 3 Physiologically wellcompensated patients with CHD can undergo elective operations at minimal risk, whereas poorly compensated patients undergoing urgent or major operations are at high risk. 3 In addition to complexity and physiological status, other risk factors are type of surgery, age, length of hospital stay before surgery, and ASA physical status IV or V. On the basis of the available evidence, a pragmatic attempt has been made to classify children as high, intermediate and low risk in order to aid management (Table 1).…”