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Preoperative Risk Scoring System for Infants and Young Children Undergoing Cardiothoracic Surgery (PREdICt): A Proposed Risk Stratification Method to Predict Postoperative Pulmonary Complications in Children Six Years Old and Below Undergoing Cardiothoracic Surgery at the Philippine Heart Center FREE TO VIEW

Maria Niña Banque, MD; Ma. Dulce Requiron-Sy, MD; Maria Nerissa De Leon, MD; Milagros Bautista, MD; Encarnita Limpin, MD
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Philippine Heart Center, Quezon City, Philippines

Chest. 2013;144(4_MeetingAbstracts):777A. doi:10.1378/chest.1697902
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SESSION TITLE: Pediatric Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Predicting the risks of developing postoperative pulmonary complications in infants and young children undergoing cardiothoracic surgery has always been a challenge. This study aimed to propose a risk stratification method for postoperative pulmonary complications among children 6 years old and below who will undergo cardiothoracic surgery.

METHODS: We prospectively followed 286 children, aged 6 years old and below, who underwent cardiothoracic surgery from September-March 2013. Preoperative risk factors included age, gender, weight, cardiac diagnosis, type of surgery, history of respiratory tract infection and reactive airways disease and the need for preoperative mechanical ventilation. Laboratory data included complete blood count, blood gas, serum albumin, bleeding parameters,2D echocardiogram and tidal breathing analysis. ASA and RACHS-1 scoring were also included. Primary outcome measure is postoperative pulmonary complication and secondary outcome measures included duration of postop mechanical ventilation, recovery room and PICU stay, overall length of postoperative hospital stay and death.

RESULTS: : Two hundred eighteen (76%) out of the 286 children developed postoperative pulmonary complications, with atelectasis, pneumonia and air leaks as the most frequent complication noted. Among the clinical variables analyzed, 14 variables were independent predictors of postoperative pulmonary complications: age <28 days old, weight of <8.85kg, history of RTI and reactive airways disease, use of mechanical ventilation preop, pulmonary hypertension, pH <7.35 and >7.45, pO2 <80, wbc <5 and >10, neutrophils >39.5, lymphocytes <47.5, serum albumin <32, high ASA and RACHS-1 score. ROC analysis derived the best minimum cut off score of 7 points, with a lowest and highest achievable score of 1 and 20 respectively and with a sensitivity of 86.7% and specificity 55.9% .

CONCLUSIONS: Pulmonary risk assessment provides a measure of healthcare service quality so that healthcare service providers will provide the lowest rate of complications, shortest hospital stay and lowest mortality. To know the risk profile of the patient, one can individualize strategies to prevent complications.

CLINICAL IMPLICATIONS: The use of this scoring system will help us screen, categorize, and risk stratify children 6 year old and below before subjecting them to surgery.

DISCLOSURE: The following authors have nothing to disclose: Maria Niña Banque, Ma. Dulce Requiron-Sy, Maria Nerissa De Leon, Milagros Bautista, Encarnita Limpin

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