TY - JOUR
T1 - Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients
T2 - A Cross-Sectional Study from the Society of Thoracic Surgeons and Congenital Cardiac Anesthesia Society Database Collaboration
AU - Long, Justin B.
AU - Engorn, Branden M.
AU - Hill, Kevin D.
AU - Feng, Liqi
AU - Chiswell, Karen
AU - Jacobs, Marshall L.
AU - Jacobs, Jeffrey P.
AU - Goswami, Dheeraj
N1 - Funding Information:
Funding: This study was supported by the Society of Thoracic Surgeons (STS), Chicago, IL, which supports the Congenital Heart Surgery Database and funded the data report and statistical analysis for this study.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - BACKGROUND: We sought to examine potential associations between pediatric postcardiac surgical hematocrit values and postoperative complications or mortality. METHODS: A retrospective, cross-sectional study from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and Congenital Cardiac Anesthesia Society Database Module (2014-2019) was completed. Multivariable logistic regression models, adjusting for covariates in the STS-CHSD mortality risk model, were used to assess the relationship between postoperative hematocrit and the primary outcomes of operative mortality or any major complication. Hematocrit was assessed as a continuous variable using linear splines to account for nonlinear relationships with outcomes. Operations after which the oxygen saturation is typically observed to be <92% were classified as cyanotic and ≥92% as acyanotic. RESULTS: In total, 27,462 index operations were included, with 4909 (17.9%) being cyanotic and 22,553 (82.1%) acyanotic. For cyanotic patients, each 5% incremental increase in hematocrit over 42% was associated with a 1.31-fold (95% confidence interval [CI], 1.10-1.55; P =.003) increase in the odds of operative mortality and a 1.22-fold (95% CI, 1.10-1.36; P <.001) increase in the odds of a major complication. For acyanotic patients, each 5% incremental increase in hematocrit >38% was associated with a 1.45-fold (95% CI, 1.28-1.65; P <.001) increase in the odds of operative mortality and a 1.21-fold (95% CI, 1.14-1.29; P <.001) increase in the odds of a major complication. CONCLUSIONS: High hematocrit on arrival to the intensive care unit (ICU) is associated with increased operative mortality and major complications in pediatric patients following cardiac surgery.
AB - BACKGROUND: We sought to examine potential associations between pediatric postcardiac surgical hematocrit values and postoperative complications or mortality. METHODS: A retrospective, cross-sectional study from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and Congenital Cardiac Anesthesia Society Database Module (2014-2019) was completed. Multivariable logistic regression models, adjusting for covariates in the STS-CHSD mortality risk model, were used to assess the relationship between postoperative hematocrit and the primary outcomes of operative mortality or any major complication. Hematocrit was assessed as a continuous variable using linear splines to account for nonlinear relationships with outcomes. Operations after which the oxygen saturation is typically observed to be <92% were classified as cyanotic and ≥92% as acyanotic. RESULTS: In total, 27,462 index operations were included, with 4909 (17.9%) being cyanotic and 22,553 (82.1%) acyanotic. For cyanotic patients, each 5% incremental increase in hematocrit over 42% was associated with a 1.31-fold (95% confidence interval [CI], 1.10-1.55; P =.003) increase in the odds of operative mortality and a 1.22-fold (95% CI, 1.10-1.36; P <.001) increase in the odds of a major complication. For acyanotic patients, each 5% incremental increase in hematocrit >38% was associated with a 1.45-fold (95% CI, 1.28-1.65; P <.001) increase in the odds of operative mortality and a 1.21-fold (95% CI, 1.14-1.29; P <.001) increase in the odds of a major complication. CONCLUSIONS: High hematocrit on arrival to the intensive care unit (ICU) is associated with increased operative mortality and major complications in pediatric patients following cardiac surgery.
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U2 - 10.1213/ANE.0000000000005416
DO - 10.1213/ANE.0000000000005416
M3 - Article
C2 - 33721876
AN - SCOPUS:85119153772
SN - 0003-2999
VL - 133
SP - 1077
EP - 1088
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 5
ER -