背景:患有先天性心脏病(CHD)的儿童通常需要其他,非心脏相关的外科手术后,他们的初始心脏手术。完成全部或部分CHD修复后,他们术后并发症的风险仍然增加。我们检查了接受腹部普外科手术的婴儿的先前心脏介入(手术或经皮导管介入)与术后肺炎的关系。
方法:一项1:1倾向评分匹配的研究是在2012年至2022年期间在美国参与国家外科质量改进计划的医院进行腹部手术的104,820名婴儿(<12个月)的回顾性队列研究。主要结果是术后30天内的肺炎。次要结果包括非计划再插管,长时间机械通气(>72小时),并延长住院时间(研究队列>第75百分位数)。
结果:在研究队列中,9736名婴儿(9.3%)曾接受过心脏介入治疗。在倾向得分匹配的样本中,曾接受过心脏手术的婴儿术后肺炎的风险增加(1.3%vs0.8%;调整后相对危险度[RRadj]:1.64,95%CI:1.22,2.18,p=0.001),非计划再插管(57.8%vs32.6%;RRadj:1.77,95%CI:1.77,1.85,p<0.001),长时间机械通气(5.0%vs2.3%;RRadj:2.14,95%CI:1.83,2.52,p<0.001),住院时间延长(61.0%vs53.8%;RRadj:1.13,95%CI:1.10,1.17,p<0.001)。
结论:既往心脏介入治疗史会增加术后肺炎的风险,计划外的气管再插管,长时间机械通气,以及腹部手术后住院时间更长。临床医生应密切监测这些患者术后呼吸道并发症。
方法:II.
BACKGROUND: Children with congenital heart disease (CHD) often require other, non-cardiac related surgical procedures following their initial cardiac surgery. After full or partial CHD repair, they remain at increased risk of postoperative complications. We examined the association of previous cardiac intervention (surgery or percutaneous catheterization intervention) with postoperative pneumonia in infants undergoing abdominal general surgery.
METHODS: A 1:1 propensity score-matched study was conducted using a retrospective cohort of 104,820 infants (<12 months) who had general abdominal surgeries between 2012 and 2022 in U.S. hospitals participating in the National Surgical Quality Improvement Program. The primary outcome was postoperative pneumonia within 30 days. Secondary outcomes included unplanned reintubation, prolonged mechanical ventilation (>72 h), and extended hospital stay (>75th percentile for the study cohort).
RESULTS: Of the study cohort, 9736 infants (9.3%) had previous cardiac interventions. In the propensity score-matched sample, infants with previous cardiac surgery had increased risks of postoperative pneumonia (1.3% vs 0.8%; adjusted relative risk [RRadj]: 1.64, 95% CI: 1.22, 2.18, p = 0.001), unplanned reintubation (57.8% vs 32.6%; RRadj: 1.77, 95% CI: 1.77, 1.85, p < 0.001), prolonged mechanical ventilation (5.0% vs 2.3%; RRadj: 2.14, 95% CI: 1.83, 2.52, p < 0.001), and prolonged hospital stays (61.0% vs 53.8%; RRadj: 1.13, 95% CI: 1.10, 1.17, p < 0.001).
CONCLUSIONS: A history of previous cardiac intervention carries an increased risk of postoperative pneumonia, unplanned tracheal reintubation, prolonged mechanical ventilation, as well as longer hospital stays following intra-abdominal surgery. Clinicians should closely monitor these patients for respiratory complications after surgery.
METHODS: II.