Preoperative percutaneous oxygen saturation is a predictor of postoperative adverse events after Ebstein's anomaly reconstruction

Abstract

Background Ebstein's anomaly (EA) is a kind of congenital heart disease, which is currently widely treated by cone reconstruction. However, the prediction of postoperative recovery is still challenging. Methods A retrospective analysis was performed on EA cases undergoing cone reconstruction from January 2010 to January 2016. Univariate and multivariate logistic regression analyses were performed, with postoperative adverse events defined as dependent variable and pre‐ and intraoperative parameters defined as independent variables. The predictive capacity of preoperative percutaneous oxygen saturation (SPO2) and Great Ormond Street (GOS) score was evaluated using areas under the curve of the receiver operating characteristic (ROC). Results Preoperative SPO2 was 95.7 ± 5.20%. Cardiopulmonary bypass, aortic cross‐clamp, postoperative mechanical ventilation, and hospitalization time were 101.7 ± 28.26 min, 60.9 ± 18.04 min, 16 h (8, 22), and 8 days (7, 11), respectively. The incidence of total postoperative adverse events, including low cardiac output syndrome, mechanical ventilation more than 3 days, postoperative hospitalization more than 2 weeks, postoperative reintubation, extracorporeal membrane oxygenation assistance, and death, was 13.1% (n = 13). Low preoperative SPO2 (p = .001, odds ratio [OR] = 0.834), GOS score (p = .021, OR = 0.368), and cardiopulmonary bypass time (p = .034, OR = 1.021) were risk factors for adverse events. Multivariate logistic regression analysis showed that low preoperative SPO2 (p = .002, OR = 0.846) and GOS score (p = .043, OR = 0.577) were independent risk factors for adverse events. The areas of SPO2 and GOS score under the ROC curve were 0.764 and 0.740, respectively. Conclusions Low preoperative SPO2 and GOS score were predictors of adverse events after cone reconstruction, and SPO2 was more convenient and objective than the GOS score.

Evolução do Tratamento e o Impacto dos Fatores Preditores Pré-Cirúrgicos nos Desfechos de Pacientes com Doença Cardíaca Congênita

“…Studies that report SpO2 as a possible predictor of adverse events in these patients have measured SpO2 at rest. 12,13 The difference that we identified in the present study by Inoue et al 11 is the performance in SpO2 at the time of recovery to the 6MWT. This variable may prove to be a new relevant measure in evaluating this population studied.…”

Commentary: Predictors of postoperative adverse events after cone reconstruction for Ebstein's anomaly

“…Postoperative tricuspid regurgitation (TR) significantly improves after cone reconstruction, however, RV function typically does not improve until much later 6‐8 . Patients in the reported cohort who did poorly mostly had severe TR preoperatively, although this was not significant which may be related to a small sample size 5 . Although all patients underwent preoperative echocardiography, the investigators do not comment on postoperative echocardiography data.…”

“…Efforts to predict perioperative complications and prognosis are becoming increasingly important as healthcare resources are further constrained 4 . Yang et al 5 are to be commended on a well‐written manuscript evaluating the utility of preoperative percutaneous oxygen saturation as a predictive outcome following cone reconstruction of EA 5 …”