Original article
Pediatric cardiac
Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

https://doi.org/10.1016/j.athoracsur.2009.11.048Get rights and content

Background

In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population.

Methods

Using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we created a multivariable model in which the primary outcome was major infection (septicemia, mediastinitis, or endocarditis). Candidate-independent variables included demographic characteristics, comorbid conditions, preoperative factors, and cardiac surgical procedures. We created a reduced model by backward selection and then created an integer scoring system using a scaling factor with scores corresponding to percent risk of infection.

Results

Of 30,078 children from 48 centers, 2.8% had major infection (2.6% septicemia, 0.3% mediastinitis, and 0.09% endocarditis). Mortality and postoperative length of stay were greater in those with major infection (mortality, 22.2% versus 3.0%; length of stay >21 days, 69.9% versus 10.7%). Young age, high complexity, previous cardiothoracic operation, preoperative length of stay more than 1 day, preoperative ventilator support, and presence of a genetic abnormality were associated with major infection after backward selection (p < 0.001). Estimated infection risk ranged from less than 0.1% to 13.3%; the model discrimination was good (c index, 0.79).

Conclusions

We created a simple bedside tool to identify children at high risk for major infection after cardiac surgery. These patients may be targeted for interventions to reduce the risk of infection and for inclusion in future clinical trials.

Section snippets

Data Source

The Society of Thoracic Surgeons Congenital Heart Surgery Database was founded in 2002 to support quality improvement in heart surgery. Data elements include demographic information, cardiac and noncardiac anomalies, comorbid conditions, type of operation, and outcomes including in-hospital mortality, major complications, and length of stay. We obtained approval from the Duke Institutional Review Board for waiver of consent on the basis of the unidentified nature of the data.

Patient Population

We evaluated

Demographic Characteristics and Infection

We analyzed a total of 30,078 cases in the Society of Thoracic Surgeons Congenital Cardiac Surgery Database. From this cohort, 857 patients (2.8%) had major infection (2.6% septicemia, 0.3% mediastinitis, 0.09% endocarditis). Thirty-two patients had more than one type of infection. Of patients with major infection, the mean age was 6.5 months (versus 2.4 years for the entire cohort). Fifty-five percent of patients were male in both the entire cohort and in those with major infection. Both

Comment

Our study confirms that major infection after congenital heart surgery is a complication with significant sequelae. Using a large multicenter patient population, we identified risk factors for major infection and created a clinical tool that can be used preoperatively to estimate a patient's infection risk. We validated the model internally showing that it has good discrimination.

Previous studies have evaluated risk factors for specific types of postoperative infections. Cardiopulmonary bypass,

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