What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study
Stephen Morris,
Serban Stoica,
Andrew Parry,
Christina Pagel,
Jo Wray,
David J Barron,
Karen Sheehan,
Kathleen Selway,
Lyvonne Tume,
Jane Cassidy,
Alison Jones,
John Stickley,
David Anderson,
Deborah Ridout,
Peter Davis,
Emma Hudson,
Andrew Mclean,
Warren Rodrigues,
Thomas Witter,
Victor T Tsang,
Sheryl Snowball,
Luke Maidment,
Sarah Bohannon,
Kate Penny-Thomas,
Joanne Webb,
Sinead Cummins,
Natasha Khan,
Teresa Dickson,
Ray Samson,
Isobel Mcleod,
Paul Wellman,
Rhian Lakhani,
Carrie Cherrington,
Rob Tulloh,
Bill Gaynor,
Rodney Franklin,
Lisa Allera,
Kate Bull,
Trevor Ritchens,
Branko Mimic,
Jon Smith,
Vibeke Hjortdal,
Michael Vath,
Tom Treasure,
Anne Keatley Clarke,
Bea Tuten
Affiliations
Stephen Morris
University of Cambridge, Cambridge, UK
Serban Stoica
Bristol Heart Institute, University of Bristol, Bristol, UK
Andrew Parry
Bristol Heart Institute, University of Bristol, Bristol, UK
Christina Pagel
professor of operational research
Jo Wray
Centre for Outcomes and Experience Research in Children`s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
David J Barron
4 Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Karen Sheehan
Bristol Royal Hospital for Children, University Hospitals Bristol and Weston Foundation NHS Trust, Bristol, UK
Kathleen Selway
Lyvonne Tume
Child Health, University of Salford, Salford, Greater Manchester, UK
Jane Cassidy
Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
Alison Jones
Paediatric Intensive Care Unit, Birmingham Women`s and Children`s NHS Foundation Trust, Birmingham, UK
John Stickley
Paediatric Cardiac Surgery, Birmingham Children`s Hospital, Birmingham, West Midlands, UK
David Anderson
Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
Deborah Ridout
1 University College London, London, UK
Peter Davis
Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
Emma Hudson
Velindre University NHS Trust, Cardiff, UK
Andrew Mclean
honorary associate
Warren Rodrigues
GOSH
Thomas Witter
Evelina London Children`s Hospital, London, UK
Victor T Tsang
Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
Sheryl Snowball
Luke Maidment
Sarah Bohannon
Kate Penny-Thomas
Joanne Webb
Sinead Cummins
Natasha Khan
Teresa Dickson
Ray Samson
Isobel Mcleod
Paul Wellman
6 Department of Paediatric Intensive Care, Evelina London Children`s Hospital, London, UK
Rhian Lakhani
Carrie Cherrington
Rob Tulloh
Bill Gaynor
Rodney Franklin
Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
Lisa Allera
Kate Bull
Trevor Ritchens
Branko Mimic
Jon Smith
Cardiothoracic Directorate, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Objectives Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.Design The design was a prospective, multicentre, multidisciplinary mixed methods study.Setting The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.Participants Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.Results Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).Conclusions Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.
