Definition of important early morbidities related to paediatric cardiac surgery.

Katherine L Brown,Liz Smith,Christina Pagel,Peter Davis,Martin Utley,Kate Bull,Natasha Khan,Rodney C Franklin,Victor Tsang,Andrew Mclean,Rhian Brimmell,Sara Thorne,Linda Chigaru,Jo Wray,Warren Rodrigues,Aparna Hoskote

doi:10.1017/s1047951116001256

Abstract

Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is "generally bad for you", and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance. As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients. We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity. It is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.

Highlights

Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance
Multiple morbidities and items not included Within the context of the present study,[23] which aims to prospectively measure the incidence and impact of defined morbidity events, the approach to the number of morbidities in a given patient will be to identify single morbidity events as defined (1–9), extracorporeal life support morbidity events, which may incorporate further identified morbidities alongside, and multiple morbidities in instances where a patient has one or more morbidities excluding extracorporeal life support
We present a list of consensus-based definitions of morbidities arising with paediatric cardiac surgery that have been designed for prospective audit

Summary

Introduction

Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance. The main focus of our study, which has a national setting in the United Kingdom, is upon early paediatric cardiac surgical morbidities that are considered potentially avoidable, reducible, or can be mitigated This is important to achieve as children who experience prolonged hospitalisation with complications, which are occurrences associated with an intervention that represent a departure from the desired course of events and are linked to suboptimal outcome[1], are at greater risk of death[2,3] over the long term, children with specific heart conditions who experienced prolonged stays in hospital following surgery developed higher levels of neurological disability.[4,5] Prolonged stays in hospital may be required when a patient takes longer to recover after surgery because of complications, but it is well recognised that prolonged hospitalisation may itself expose patients to the likelihood of further hospital-associated adverse events. A significant complication of paediatric cardiac surgery and mechanical circulatory support is linked to neurological disability in around 50% of cases[6] and may cost in excess £10,000/day to implement.[7,8]

Methods

Results

Conclusion