Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: a retrospective observational study

Abstract

Background

Despite improvements in neonatal cardiac surgery and postoperative care, hospitalized death for infants with low birth weight remains high.

Objective

This study sought to identify predictors of postoperative outcomes in low-birth-weight infants undergoing congenital heart surgery and establish nomograms to predict postoperative intensive-care unit (ICU) stay.

Methods

From June 2009 to June 2018, a retrospective review of 114 infants with low birth weight (≤2.5 kg) undergoing congenital heart surgery was conducted at Guangdong Provincial People’s Hospital. Purely surgical ligation of patent ductus arteriosus was excluded from this study. A total of 26 clinical variables were chosen for univariate, multivariate, and Cox regression analysis, and 14 variables were analyzed as predictors of postoperative outcomes. Nomograms were established to predict risk of postoperative cardiac ICU (CICU) stay, postoperative neonatal ICU (NICU) stay, and total ICU length of stay in infants with cardiac diseases.

Results

Two variables were independent predictors in multiple logistic regression analysis of hospitalized death: operation weight and Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STAT) risk categories. Six variables were independent predictors in the Cox model of postoperative ICU length of stay, including sex, prematurity, birth weight, preoperative stay time in NICU, diagnostic classification, and STAT risk categories. We calculated concordance-index values to estimate the discriminative ability of models of risk of postoperative CICU stay, postoperative NICU stay, and total ICU length of stay, with values of 0.758 (95% CI 0.696–0.820), 0.604 (95% CI 0.525–0.682), and 0.716 (95% CI 0.657–0.776), which indicated the possibility of true-positive results.

Conclusion

Our findings might help clinicians predict postoperative outcomes and optimize therapeutic strategies.

Keywords:

• low birth weight
• congenital heart disease
• neonatal cardiac surgery
• outcome prognosis
• predictive tools
• nomogram

Acknowledgment

We would like to thank Shanghai Ruihui Biotech for data processing and management.

Abbreviation list

PDA, patent ductus arteriosus; CoA, coarctation of aorta; ASD, atrial septal defect; VSD, ventricular septal defect; PFO, patent foramen ovale; TOF, tetralogy of Fallot; TAPVC, total anomalous pulmonary venous drainage; TGA, (complete) transposition of great arteries; IVS, interventricular septum; PA, pulmonary atresia; PS, pulmonary artery stenosis; PTA, permanent trunk of artery; IAA, interruption of aortic arch, AP, aortopulmonary, LBW, low birth weight, IGUR, intrauterine growth restriction, STAT, Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery; ICU, intensive-care unit; NICU, neonatal ICU; CICU, cardiac ICU; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest.

Availability of data and material

All data supporting our findings will be shared on request. Contact Sheng Wang via [email protected].

Ethics approval and consent to participate

The Institutional Review Committee of Guangdong Provincial People’s Hospital approved this study, and all investigations were conducted in accordance with ethical research principles. Patient consent was not required.

Supplementary material

Table S1 Patient characteristics of 114 infants undergoing congenital heart surgery

Table S2 Cox proportional-hazard model of quantitive outcomes

Author contributions

SW, JZ, LY, and CL designed the study. CL, LY, SW, JZ, and JW gathered the data. JC, SW, JZ, LY, and CL analyzed the data. CL, LY, JW, JC, JZ, and SW wrote the manuscript and agree to be responsible for its contents. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work

Disclosure

JZ received funding from Guangdong Project of Science and Technology (2017A070701013 and 2017B090904034). SW received funding from the Natural Science Foundation of Guangdong Province (2018A030313535). The authors report no other conflicts of interest in this work.