Improving and standardizing capture of pediatric cardiac surgical complications

Abstract

Objective: Our objective was to establish baseline data and develop a tool to allow for systematic evaluation of pediatric cardiac surgical complications. As a first step, we examined the incidence and distribution of complications, risk stratified by case complexity in a single institution. With improving mortality rates for congenital heart surgery, the next frontier for improving patient outcomes is characterizing and reducing complications. Currently, no standardized approach is available to monitor the incidence and severity of all complications associated with a congenital cardiac surgery program.Methods: Complications occurring in pediatric cardiac surgical patients (January 2006 to March 2009) were collected by database review applying standardized definitions. The surgical procedures were stratified by complexity to analyze the distribution of complications over the risk spectrum. Each complication was assigned a severity coefficient (1-3) used to calculate the combined effect of frequency and severity. The cumulative sum method was used to determined the trend of the adverse outcomes.Results: Of 292 procedures, 84 (28.8%) were associated with a total of 150 complications. Of the 150 complications, 37 occurred in patients who died. The most common complications were arrhythmias (14.5%), cardiac (12.6%), and operative (12.6%). There was a linear relationship between the frequency and severity of complications and surgical complexity, as stratified using the Risk Adjustment for Congenital Heart Surgery category or Aristotle basic complexity levels (Spearman's coefficient ¼ 1).Conclusions: When examined in a systematic fashion, the risk of complications in pediatric cardiac surgical patients is considerable. Our data illustrate that it is possible to track complications over time in a consistent manner. The effect of complication monitoring on patient outcomes remains to be proved.

Evaluation of Complications of Heart Surgery in Children With Congenital Heart Disease at Dena Hospital of Shiraz

“…In the study done by Hornick et al (2011) , arrhythmias has assigned 19.2%, reduced cardiac output 16.2% and block nodes AV 2.8% ( Hornik, Jacobs, Li, Jaquess, & Jacobs,2011 ). Also, in the done by study Shanmogam et al (2012) , cardiac and arrhythmias effects assigned 14.5% higher risk of post-operative heart ( Shanmugam, Clark L, Burton, Warren, & O’Blenes, 2012 ). Cardiothoracic surgery in children is often associated with decreased cardiac output in the postoperative period ( Barker et al, 2013 ).…”

Should early extubation be the goal for children after congenital cardiac surgery?

“…Compared with published standards, our program has had low mortality and complication rates. The aggregate multi-institutional mortality for pediatric cardiac surgery is 4% 16,17 and 32% of operations are associated with 1 complication. 18 In contrast, we found a mortality rate of 1.5% and a complication rate of 27%.…”

Systematic review of grading systems for adverse surgical outcomes

“…We identified 9 studies on 8 grading systems for adverse postoperative outcomes with frameworks generalizable to any surgical procedure (Table 1). 1,8,9,11,[18][19][20][21][22][23] The Clavien-Dindo system and the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0) 19 were the most commonly cited systems, followed by the Comprehensive Complication Index (CCI). 12 The other systems identified did not appear to be widely incorporated in the literature.…”

“…With the Pediatric Cardiac Surgical Complication Assessment tool, 23 the severity of adverse postoperative outcomes is graded from 0 to 100 based on clinical expert consensus regarding the permanence of the complication. The composite severity score is calculated based on the formula Σ (frequency × severity) of adverse postoperative outcomes of a given patient cohort.…”