Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals

Pirouz Shamszad; Joseph W Rossano; Bradley S Marino; Adam W Lowry; Jarrod D Knudson

doi:10.1111/chd.12325

Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals

Congenit Heart Dis. 2016 Sep;11(5):409-414. doi: 10.1111/chd.12325. Epub 2016 Feb 17.

Authors

Pirouz Shamszad¹, Joseph W Rossano², Bradley S Marino³, Adam W Lowry⁴, Jarrod D Knudson⁵

Affiliations

¹ Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA. shamszadp@email.chop.edu.
² Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA.
³ Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
⁴ Department of Cardiology, Children's National Medical Center, Washington, DC, USA.
⁵ Department of Pediatrics, Children's Heart Center, Division of Critical Care, Children's of Mississippi, University of Mississippi Medical Center, Jackson, Miss, USA.

PMID: 26887350
DOI: 10.1111/chd.12325

Abstract

Objective: To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals.

Design: A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed.

Setting: Tertiary children's hospitals in the United States.

Patients: All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score.

Outcome measures: Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant.

Results: Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group ($38,031 [IQR $31,900-$48,844] vs. ($41,896 [IQR $32,854-$56,020], P < .001). Mortality was similar between cases and controls (22% vs. 1.9%, P =.692). Surgical complications occurred similarly between cases and controls (13.5% vs. 12.4%, P = .535). Cases had longer intensive care unit length of stay than controls (3 vs. 2 days, P = .001), resulting in longer overall hospital length of stay (5 vs. 4 days, P < .001). Cases also had a higher odds of undergoing mechanical ventilation for >96 hours (OR 2.0, 95% CI 1.1-3.7) and higher rate of total parenteral nutrition use (7.2% vs. 4.5%, P = .040). Median hospital charges were higher in cases (clinical: $6,696 vs. $5,872; laboratory: $14,168 vs. $12,251; pharmacy: $12,971 vs. $10,426; imaging: $6,259 vs. $5,660; P ≤ .030 for all).

Conclusions: The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.

Keywords: Cardiac Surgery; Complications; Diabetes Mellitus; Hospital Utilization; Obesity.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Cardiac Surgical Procedures / adverse effects*
Case-Control Studies
Child
Diabetes Mellitus / epidemiology*
Female
Heart Defects, Congenital / complications
Heart Defects, Congenital / surgery*
Hospital Mortality / trends
Hospitals, Pediatric / statistics & numerical data*
Humans
Incidence
Inpatients*
Length of Stay / trends
Male
Pediatric Obesity / complications*
Pediatric Obesity / epidemiology
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Prognosis
Survival Rate / trends
United States / epidemiology
Young Adult