Our Summary

This study looks at unplanned surgeries (uRE) after a child has undergone heart surgery. These unplanned operations can be seen as a measure of how well the initial surgery went and the child’s health following the operation. The research was carried out across five UK centers between 2015 and 2017, with data from 3090 surgeries involving 2861 patients.

The study found that about 4.7% of the surgeries led to unplanned additional operations. The death rate within 30 days and six months after surgery was higher in patients who required an unplanned operation compared to those who didn’t. This was true even when considering other factors like the child’s age, weight, and specific heart conditions.

Interestingly, while factors like a younger age, low weight, and certain heart conditions increased the likelihood of needing an unplanned operation, the “Partial Risk Adjustment in Surgery” score - a measure used to predict death risk after surgery - did not.

The study concluded that unplanned operations are a relatively common complication after pediatric heart surgery and are associated with a higher early death rate. This higher death rate was linked to other complications after the initial surgery, rather than pre-surgery factors.

FAQs

  1. What percentage of pediatric heart surgeries led to unplanned additional operations according to the study?
  2. Did the “Partial Risk Adjustment in Surgery” score predict the likelihood of needing an unplanned operation after pediatric heart surgery?
  3. What factors were found to increase the likelihood of needing an unplanned operation after pediatric heart surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric cardiac surgery is to closely monitor their child’s recovery after the initial surgery and to promptly report any concerning symptoms or changes in their condition. This can help catch any potential complications early and prevent the need for additional unplanned surgeries. It’s also important for parents to follow the post-operative care instructions provided by the medical team to ensure the best possible outcome for their child.

Suitable For

Patients who may be recommended for pediatric cardiac surgery include those with congenital heart defects, acquired heart diseases, valve abnormalities, and other heart conditions that require surgical intervention. These patients may range from newborns to adolescents and may have complex medical histories that necessitate specialized care from a pediatric cardiac surgeon.

Timeline

Overall, the timeline for a patient before and after pediatric cardiac surgery can be summarized as follows:

Before surgery:

  • Patient diagnosis of heart condition
  • Consultation with cardiac surgeon and medical team
  • Pre-operative testing and evaluation
  • Discussion of surgical options and risks with family
  • Admission to hospital for surgery

After surgery:

  • Immediate post-operative care in ICU
  • Monitoring for complications and recovery
  • Possible need for unplanned additional surgeries
  • Transition to general hospital ward
  • Rehabilitation and physical therapy
  • Follow-up appointments with medical team
  • Long-term management of heart condition

The study highlighted the importance of monitoring and managing the risks associated with pediatric heart surgery, particularly in identifying and addressing complications that may arise following the initial operation. This can help improve outcomes and reduce the likelihood of additional surgeries and associated risks for pediatric patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric cardiac surgery include:

  1. What is the success rate of the specific heart surgery my child will undergo?
  2. What are the potential complications or risks associated with the surgery?
  3. How many pediatric cardiac surgeries have you performed, and what is your experience with this specific procedure?
  4. What is the expected recovery time for my child after the surgery?
  5. How will my child be monitored and cared for post-surgery?
  6. What signs or symptoms should I watch for that may indicate a need for further medical attention?
  7. What is the likelihood of my child needing an unplanned operation after the initial surgery?
  8. How will my child’s risk for complications be assessed before and after the surgery?
  9. What support services are available for my child and our family during the surgical process and recovery period?
  10. Are there any specific lifestyle changes or medications my child will need to follow post-surgery to promote healing and prevent complications?

Reference

Authors: Dorobantu DM, Ridout D, Brown KL, Rodrigues W, Sharabiani MTA, Pagel C, Anderson D, Wellman P, McLean A, Cassidy J, Barron DJ, Tsang VT, Stoica SC. Journal: J Thorac Cardiovasc Surg. 2021 Mar;161(3):1155-1166.e9. doi: 10.1016/j.jtcvs.2020.10.145. Epub 2020 Nov 27. PMID: 33419533