"Low Body Weight and Failure to Gain Weight are Risk Factors for Heart Surgery in Children"-Doctors Should Stop Saying That to Parents

Are neonatal age and small weight predictive of in-hospital death and prolonged hospital stay in children undergoing heart surgery?

Background

The effect of young age and low weight on outcomes of congenital heart disease surgery is controversial. It is still widely believed both by parents and referring cardiologists that they do have a significant deleterious effect and may prohibit surgical care. This study was intended to determine the independent predictors of in-hospital death and prolonged hospital stay in pediatric patients undergoing cardiac surgery. The effects of age and weight were the focus of analysis. To adjust for heterogeneity and complexity, the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system and other factors were used.

Results

All patients between birth and 18 years of age who underwent cardiac surgery with or without the use of cardiopulmonary bypass from April 1, 2011, to September 30, 2019, were included. Patients undergoing isolated patent ductus ligation were excluded. For the analysis of in-hospital death, a multivariable logistic regression model was used. For the analysis of length of stay, a generalized linear regression model with Poisson distribution and a multivariable logistic regression model were used. The RACHS-1 categories were used to adjust for complexity.

The study included 934 index operations. Neonates (age < 28 days) accounted for 11% of the operations. After adjusting for complexity and other operative variables, we found that age and weight were not significant predictors of in-hospital death or prolonged hospital stay. RACHS category and cardio-pulmonary bypass time were, however, significant predictors of in-hospital mortality, p value 0.009, and 0.002, respectively. The complexity of the operation was also predictive of prolonged hospital stay.

Conclusion

Age and weight are not significant predictors of in-hospital death or prolonged hospital stay. Except for severe prematurity and prohibitive genetic or metabolic disease, patients with CHD should get appropriate and expeditious surgical care regardless of age and weight.