Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Abstract

Background:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

Towards Zero Phrenic Nerve Injury in Reoperative Pediatric Cardiac Surgery: The Value of Intraoperative Phrenic Nerve Stimulation

“…Waiting after confirming diaphragmatic dysfunction results in a prolonged need for ventilatory/respiratory support, recurrent intubation, increased risk of postoperative pneumonia, prolonged ICU and hospital stay, and even mortality. In a multicenter study of 112,110 patients from 43 hospitals through the pediatric health information system database, the authors found a 2.2% overall incidence of diaphragmatic paralysis, with 24% (603 patients) requiring plication [1]. The authors also noted that infants under one month of age exhibited the greatest requirement for plication, and conversely, as the child's age increased, the likelihood of necessitating plication diminished.…”

“…A total of 147 patients underwent repeat sternotomy between September 2011 and August 2021. Inclusion criteria were children (<18 years of age) who underwent repeat sternotomy for procedures that either (1) required dissection close to the phrenic nerve, or (2) are known to be associated with phrenic nerve injury. These included distal pulmonary arterial reconstruction, unifocalization, change to the pulmonary conduit, bidirectional cavopulmonary anastomosis, Fontan, aortic arch repair, and heart transplantation.…”

“…The reported incidence of phrenic nerve injury after pediatric cardiac surgery has been 2.2% in some studies [1]. In procedures that require dissection deep in the lung hilum, mobilization of the superior vena cava, and all work on the distal aortic arch, the phrenic nerve is at an even greater risk of injury.…”

ÇOCUKLARDA ve GENÇ ERİŞKİNLERDE SUBAKSİLLER SAĞ TORAKOTOMİ YAKLAŞIMIYLA (‘BİKİNİ İNSİZYONU’) MİNİMAL İNVAZİV ATRİYAL SEPTAL DEFEKT ONARIMI

“…Konjenital kalp cerrahisinde frenik sinir hasarı postoperatif morbiditeyi önemli derece etkileyen bir komplikasyondur 23 . Frenik sinir hasarında olası mekanizmalar direk yaralanma, koter kullanımına bağlı termal hasar, kontrolsüz timus diseksiyonu, askı dikişlerinin konulmasında ve traksiyonunda oluşan hasarlar, internal juguler ven kanülasyonu ve miyokardiyal korunmada uygulanan topikal soğuk olarak özetlenebilir 20 .…”

Capture rate of congenital heart defects in the Pediatric Health Information System database

“…Without a national clinical registry, administrative and claims‐based databases such as the Pediatric Health Information System (PHIS) are frequently used for source data in outcomes research. PHIS data have generated more than 150 studies involving cardiac disease alone (Beach et al, 2019; Diaz et al, 2019; Foster et al, 2020; Purifoy, Spray, Riley, Prodhan, & Bolin, 2019; Savla et al, 2019; Spinner et al, 2020; Weiner et al, 2020). Despite the widespread use of this database, PHIS accounts for only 15% of nationwide pediatric discharges.…”