Definition of important early morbidities related to paediatric cardiac surgery

Abstract

Background: Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is "generally bad for you", and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance. Methods: As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients. Results: We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity. Conclusions: It is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.

A tool for routine monitoring and feedback of morbidities following paediatric cardiac surgery

“…Below, we give a brief summary of how communication was chosen and defined for this study. A full write-up of the selection process of all measured morbidities is available in Pagel et al 6 and a full account of the definitions of each morbidity is available in Brown et al 7 (see also Supplementary File S1).…”

“…In the broader study, nine morbidities (Fig 1) were selected as important by a panel of family representatives, surgeons, intensivists, nurses, and paediatricians 6 , and then defined by a separate panel of clinicians and data managers. 7 The incidence of each complication was measured among 3090 cases between 1 October, 2015 and 30 June, 2017 at 5 United Kingdom centres. In parallel to this data collection, we sought to develop a means for centres to, routinely and in a timely manner, monitor local morbidity rates using the incidence of each morbidity from the study data as a benchmark.…”

“…Final set of morbidity icons. See Brown et al7 for morbidity definitions and their measurement protocols.…”

Validation of the Brief Developmental Assessment in pre-school children with heart disease

“…Stakeholders, especially parent groups, view the evaluation of developmental and behavioural difficulties in children with CHD as one of their highest priorities. 16 Although the benefits of early intervention for developmental difficulties has not been specifically studied in children with CHD, early intervention has been recommended across a range of paediatric contexts 17 and is supported by studies of premature infants 18 and autism; 19 early recognition and intervention is also more satisfactory to families. 20 As part of wider health screening in the United Kingdom, all children undergo periodic clinical checks with a community-based nurse referred to as a health visitor; these do not rely on formal developmental tests apart from the "Ages and Stages Questionnaire", which is used with children at the age of 2 years.…”

Parental understanding of our communication of morbidity associated with paediatric cardiac surgery: a qualitative study

“…As part of a wider study looking at the selection, definition, incidence and impact of morbidities following paediatric cardiac surgery,3 4 9 10 our objective was to elicit parents’ perceptions about the way healthcare professionals communicate regarding morbidities associated with paediatric cardiac surgery.…”