1. To develop guidelines and proposed a scoring system for pediatric risk stratification for postoperative pulmonary complications in pediatric patients undergoing cardiothoracic surgery. 2. To determine the accuracy of this simple and rapid pre-operative scoring system for postoperative pulmonary complications in pediatric patients undergoing cardiothoracic surgery.
Medical records of children aged 6 to 19 years old, who underwent thoracic surgery. Preoperative risk factors extracted include (age, gender and cardiothoracic anomalies), nutritional status, past medical history. Laboratory data include complete blood count, 2D echocardiogram, chest radiograph, pulmonary function tests and blood gas analysis.
A total of 506 children, of which 330 (65.2%)developed post-operative complications while 176 (34.8%) with none. Atelectasis (25.6%) was the top complications. Non independent predictors are:Age, hematocrit, sex, cross clamp time, wasting, bypass time, stunting, type of congenital heart disease, pre-operative 2D echo results, FVC/FEV1 ratio, FEF, paO2, paCO2, pre-operative chest x-ray, duration of mechanical ventilationAmong the clinical variables analyzed, only three variables were independently predictive of post-operative complications namely; FVC of < 80 (p = .030); blood pH of < 7.35 (p = .024) and white blood cell count of > 12 T per cubic mm (p = .0001). ROC analysis derived the best minimum cut-off score of 11 points with a sensitivity of 88.8 % and specificity of 85.1 %, LR+ of 5.41. The overall accuracy of the scoring index was 81.6% [p = .002].
Patients with congenital heart disease are at increase risk of developing postoperative pulmonary complications.Pre-operative risk stratification using this scoring index is simple and rapid. The overall accuracy of the scoring index was 81.6%.
There is no “gold standard “or international guidelines for pediatric evaluation or risk stratification for postoperative complications for cardiothoracic surgery. A multitude of procedures and tests have been described and performed in adult patients and these are often used to evaluate children and adolescent patients. This study showed the high accuracy of a simple and rapid pre-operative scoring system to predict post-operative pulmonary complications among children undergoing thoracic surgery.
Beverly Delacruz, No Financial Disclosure Information; No Product/Research Disclosure Information