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Complex Chronic Conditions Among Children Undergoing Cardiac Surgery

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Abstract

Children with complex chronic conditions (CCCs) require a disproportionate amount of inpatient resources and are at increased risk of mortality during hospital admissions. This study examines the impact of non-cardiac, comorbid complex chronic conditions on outcomes in children undergoing congenital heart surgery. All admissions associated with a congenital cardiac surgical procedure in the Kids’ Inpatient Database from 1997 to 2012 were examined. Children were classified by the number as well as type (genetic vs. non-genetic) of CCC. Baseline demographics as well as proportion of total inpatient days and total hospitalization charges was assessed. Multivariate regression models examining occurrence of a complication, mortality, prolonged length of stay and high hospitalization charges were constructed. In multivariate models, an increasing number of CCC was associated with increased risk of mortality and complications (mortality: 1 CCC: odds ratio (OR) = 1.17, 95 % CI = 1.03–1.33); ≥2 CCC: OR = 1.54, 95 % CI = 1.26–1.87). Additionally, the presence of a genetic CCC was protective against mortality (OR = 0.71, 95 % CI = 0.56–0.89) while non-genetic CCCs were associated with mortality (OR = 1.62, 95 % CI = 1.41–1.88) and high resource utilization. Over time, the proportion of genetic CCC remained stable while non-genetic CCC increased in prevalence. Complex chronic conditions have a varying association with mortality, morbidity and resource utilization in children undergoing congenital heart surgery. While genetic CCCs were not associated with poor outcomes, non-genetic CCCs were risk factors for morbidity and mortality. These findings suggest that pre-surgical counseling and surgical planning should account for the type of non-cardiac comorbid conditions.

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Authors and Affiliations

  1. Pediatric Critical Care Medicine/The Heart Center, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, M/S: FA.2.112, Seattle, WA, 98105, USA

    Titus Chan & Jane Di Gennaro

  2. Pediatric Cardiology/Medical Genetics, Duke University Medical Center, Durham, NC, USA

    Stephanie Burns Wechsler

  3. Pediatric Critical Care Medicine, University of Utah, Primary Children’s Medical Center, Salt Lake City, UT, USA

    Susan L. Bratton

Authors
  1. Titus Chan
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  2. Jane Di Gennaro
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  3. Stephanie Burns Wechsler
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  4. Susan L. Bratton
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Correspondence to Titus Chan.

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Chan, T., Di Gennaro, J., Wechsler, S.B. et al. Complex Chronic Conditions Among Children Undergoing Cardiac Surgery. Pediatr Cardiol 37, 1046–1056 (2016). https://doi.org/10.1007/s00246-016-1387-6

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  • DOI: https://doi.org/10.1007/s00246-016-1387-6

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