儿童医院中的成人先天性心脏病手术后的死亡危险因素

Risk Factors for Death After Adult Congenital Heart Surgery in Pediatric Hospitals
作者:Kim Gauvreau Bacha 【View at publisher】 【全球专家评论】
期刊: CAN MED ASSOC J2011年7月4期4卷 专家评级: 循证评级:B

BACKGROUND: Despite the central role that pediatric hospitals play in the surgical treatment of congenital heart disease, little is known about outcomes of adult congenital cardiac surgical care in pediatric hospitals. Risk factors for inpatient death, including adult congenital heart (ACH) surgery volume, are poorly described.

METHODS AND RESULTS: We obtained inpatient data from 42 free-standing pediatric hospitals using the Pediatric Health Information System data base 2000 to 2008 and selected ACH surgery admissions (ages 18 to 49 years). We examined admission characteristics and hospital surgery volume. Of 97 563 total (pediatric and adult) congenital heart surgery admissions, 3061 (3.1%) were ACH surgery admissions. Median adult age was 22 years and 39% were between ages 25 to 49 years. Most frequent surgical procedures were pulmonary valve replacement, secundum atrial septal defect repair, and aortic valve replacement. Adult mortality rate was 2.2% at discharge. Multivariable analyses identified the following risk factors for death: age 25 to 34 years (adjusted odds ratio [AOR], 2.1; P="0".009), age 35 to 49 years (AOR, 3.2; P="0".001), male sex (AOR, 1.8; P="0".04), government-sponsored insurance (AOR, 1.8; P="0".03), and higher surgical risk categories 4+ (AOR, 21.5; P="0".001). After adjusting for case mix, pediatric hospitals with high ACH surgery volume had reduced odds for death (AOR, 0.4; P="0".003). There was no relationship between total congenital heart surgery volume and ACH inpatient mortality.

CONCLUSIONS: Older adults, male sex, government-sponsored insurance, and greater surgical case complexity have the highest likelihood of in-hospital death when adult congenital surgery is performed in free-standing pediatric hospitals. After risk-adjustment, pediatric hospitals with high ACH surgery volume have the lowest inpatient mortality.

PMID: 21693722 [PubMed - indexed for MEDLINE]

学科代码:内科学 儿科学   关键词:成人先天性心脏病手术
来源: ScienceDirect
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