PDF(Pubmed)
Abstract：
UNASSIGNED: Health disparities are known to play a role in pediatric cardiac surgery outcomes.
UNASSIGNED: Risk factors associated with poor clinical outcomes were assessed.
UNASSIGNED: Using Pediatric Health Information System Database, pediatric subjects undergoing cardiac surgery using International Classification of Diseases 10th Revision from October 2015 to December 2020 were evaluated. Subjects were categorized by case complexity using the newly validated Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2). Multivariable regression analyses were conducted to ascertain risk factors.
UNASSIGNED: A total of 59,856 subjects, median age 7.4 months (IQR: 1.5-61 months) were included; 38,917 (low), 9,833 (medium), and 11,106 (high) RACHS-2. Overall, hospital mortality was 3% and postoperative length of stay (LOS) was 7 days (IQR: 4-18 days), with significant increases in both mortality and postoperative LOS from low to high RACHS-2 scores by multivariable analysis, Kaplan-Meier, and Cox regression. Mechanical ventilation, extracorporeal membrane oxygenation, infection, and surgical complication were most significantly associated with increased mortality by 1.198 to 10.227 times (P < 0.008). After controlling for these significant variables as well as RACHS-2, age at surgery and emergency/urgent admission type, multivariable analysis revealed that non-White race was associated with increased mortality (relative risk: 1.2, 95% CI: 0.729-0.955, P = 0.008) and increased postoperative LOS by 1.04 days (95% CI: 0.95-0.97, P < 0.001). This significant increase in both clinical outcomes was concordant in non-White neonates (mortality relative risk: 1.3, 95% CI: 1.1-1.6, P = 0.003; and postoperative LOS by 2.05 weeks (95% CI: 1.36-3.10, P < 0.001).
UNASSIGNED: The influence of racial differences in neonates and children should be further evaluated to mitigate any disparity in those undergoing cardiac surgery.
UNASSIGNED: Risk factors associated with poor clinical outcomes were assessed.
UNASSIGNED: Using Pediatric Health Information System Database, pediatric subjects undergoing cardiac surgery using International Classification of Diseases 10th Revision from October 2015 to December 2020 were evaluated. Subjects were categorized by case complexity using the newly validated Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2). Multivariable regression analyses were conducted to ascertain risk factors.
UNASSIGNED: A total of 59,856 subjects, median age 7.4 months (IQR: 1.5-61 months) were included; 38,917 (low), 9,833 (medium), and 11,106 (high) RACHS-2. Overall, hospital mortality was 3% and postoperative length of stay (LOS) was 7 days (IQR: 4-18 days), with significant increases in both mortality and postoperative LOS from low to high RACHS-2 scores by multivariable analysis, Kaplan-Meier, and Cox regression. Mechanical ventilation, extracorporeal membrane oxygenation, infection, and surgical complication were most significantly associated with increased mortality by 1.198 to 10.227 times (P < 0.008). After controlling for these significant variables as well as RACHS-2, age at surgery and emergency/urgent admission type, multivariable analysis revealed that non-White race was associated with increased mortality (relative risk: 1.2, 95% CI: 0.729-0.955, P = 0.008) and increased postoperative LOS by 1.04 days (95% CI: 0.95-0.97, P < 0.001). This significant increase in both clinical outcomes was concordant in non-White neonates (mortality relative risk: 1.3, 95% CI: 1.1-1.6, P = 0.003; and postoperative LOS by 2.05 weeks (95% CI: 1.36-3.10, P < 0.001).
UNASSIGNED: The influence of racial differences in neonates and children should be further evaluated to mitigate any disparity in those undergoing cardiac surgery.
摘要：
已知健康差异在小儿心脏手术结果中起作用。
■评估与不良临床结局相关的危险因素。
■使用儿科健康信息系统数据库，对2015年10月至2020年12月接受国际疾病分类第10版心脏手术的儿科受试者进行了评估.使用新验证的先天性心脏手术风险调整-2（RACHS-2）按病例复杂性对受试者进行分类。进行多因素回归分析以确定危险因素。
■总共59,856个科目，包括中位年龄7.4个月（IQR：1.5-61个月）；38,917（低），9,833（中），和11,106（高）RACHS-2。总的来说,住院死亡率为3％，术后住院时间（LOS）为7天（IQR：4-18天），通过多变量分析，死亡率和术后LOS从低到高的RACHS-2评分显着增加，Kaplan-Meier,和Cox回归。机械通气,体外膜氧合，感染,手术并发症与死亡率增加最显著相关，增加1.198~10.227倍（P<0.008）。在控制了这些重要变量以及RACHS-2，手术年龄和紧急/紧急入院类型之后，多变量分析显示，非白种人与死亡率增加相关（相对危险度：1.2，95%CI：0.729-0.955，P=0.008），术后LOS增加1.04天（95%CI：0.95-0.97，P<0.001）。在非白人新生儿中，两种临床结局的显著增加是一致的（死亡率相对危险度：1.3，95%CI：1.1-1.6，P=0.003；术后LOS为2.05周（95%CI：1.36-3.10，P<0.001）。
■应进一步评估新生儿和儿童种族差异的影响，以减轻心脏手术患者的差异。
■评估与不良临床结局相关的危险因素。
■使用儿科健康信息系统数据库，对2015年10月至2020年12月接受国际疾病分类第10版心脏手术的儿科受试者进行了评估.使用新验证的先天性心脏手术风险调整-2（RACHS-2）按病例复杂性对受试者进行分类。进行多因素回归分析以确定危险因素。
■总共59,856个科目，包括中位年龄7.4个月（IQR：1.5-61个月）；38,917（低），9,833（中），和11,106（高）RACHS-2。总的来说,住院死亡率为3％，术后住院时间（LOS）为7天（IQR：4-18天），通过多变量分析，死亡率和术后LOS从低到高的RACHS-2评分显着增加，Kaplan-Meier,和Cox回归。机械通气,体外膜氧合，感染,手术并发症与死亡率增加最显著相关，增加1.198~10.227倍（P<0.008）。在控制了这些重要变量以及RACHS-2，手术年龄和紧急/紧急入院类型之后，多变量分析显示，非白种人与死亡率增加相关（相对危险度：1.2，95%CI：0.729-0.955，P=0.008），术后LOS增加1.04天（95%CI：0.95-0.97，P<0.001）。在非白人新生儿中，两种临床结局的显著增加是一致的（死亡率相对危险度：1.3，95%CI：1.1-1.6，P=0.003；术后LOS为2.05周（95%CI：1.36-3.10，P<0.001）。
■应进一步评估新生儿和儿童种族差异的影响，以减轻心脏手术患者的差异。
