Morbidities After Cardiac Surgery: Impact on Children’s Quality of Life and Parents’ Mental Health

Abstract

Background Most children now survive cardiac surgery, and the focus of quality improvement initiatives has shifted toward more complex outcome measures. The aim of this investigation was to study the impact of early postoperative morbidities on parent-reported patient quality of life and parental anxiety or depression over 6 months. Methods This prospective case-matched cohort study was conducted in 5 UK children’s cardiac centers. Measures of impact for patient categories of “single morbidity,” “multiple morbidities,” and “extracorporeal life support (ECLS)” were compared with “no morbidity.” The measures used were the Pediatric Quality of Life Inventory (PedsQL) and the 4-item Patient Health Questionnaire (PHQ-4) at 6 weeks and 6 months postoperatively. The study modeled the outcomes using mixed effects regression, adjusting for case mix and clustering within centers. Results The study included 666 patients who underwent operation at a median age of 81 days (interquartile range, 10 to 325 days). At 6-week follow-up, significant adjusted differences to the reference group with no morbidity were found for total PedsQL scores, which were lower in patients with ECLS ( P = .01), multiple morbidities ( P < .001), and a single morbidity ( P = .04), as well as the proportion of parents with anxiety and depression, which were higher in the group with multiple morbidities ( P = .04 and P = .01, respectively). At 6 months, measures had improved in all morbidity groups. The only significant adjusted difference in the reference group was for physical PedsQL scores in ECLS ( P = .04) and multiple morbidities ( P < .01). Conclusions Patient and parent well-being are strongly influenced by postoperative morbidities early after surgery, with improvement by 6 months. Family psychological support and holistic rehabilitation are vital for children who experience postoperative morbidities.

Postoperative morbidities with infant cardiac surgery and toddlers’ neurodevelopment

“…The cardiac impact study was designed to prospectively assess the impact of postoperative morbidities on patients and families 11 18. This phase of our study followed up children who had surgery in infancy, and found evidence that a very complex postoperative course with multiple morbidities/ECLS was linked to a greater chance of neurodevelopmental difficulties at age 2–3 years than those with no morbidity following surgery.…”

“…Children were recruited as morbidity cases to the ‘cardiac impact study’ if they experienced at least one important postoperative morbidity, as selected and defined previously 10. These morbidities (defined in our previous study)17 18 were: acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, ECLS, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax. We also recruited a similar sized control sample within each centre, consisting of children matched by measures of cardiac disease complexity and chronological age, who were identified at discharge after heart surgery as having experienced no morbidities 17 18.…”

“…These morbidities (defined in our previous study)17 18 were: acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, ECLS, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax. We also recruited a similar sized control sample within each centre, consisting of children matched by measures of cardiac disease complexity and chronological age, who were identified at discharge after heart surgery as having experienced no morbidities 17 18. We undertook detailed follow-up of participants for the first 6 months after heart surgery, the results of which are reported elsewhere 17 18.…”

“…We also recruited a similar sized control sample within each centre, consisting of children matched by measures of cardiac disease complexity and chronological age, who were identified at discharge after heart surgery as having experienced no morbidities 17 18. We undertook detailed follow-up of participants for the first 6 months after heart surgery, the results of which are reported elsewhere 17 18. Here, we report follow-up of children from this cohort at the age of 2–3 years.…”

“…Given that our previous research indicated that there were gradations of morbidity severity,17 18 participants were grouped into the following three categories: ‘no morbidity’ (control group); ‘single morbidity’ (any single occurrence of one of the listed morbidities excluding ECLS) and ‘multiple morbidities/ECLS’ (more than one of the listed morbidities or ECLS).…”