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Cardiol Young. 2017 May 29:1-8. doi: 10.1017/S104795111700097X. [Epub ahead of print]

Clinical epidemiology and centre variation in chylothorax rates after cardiac surgery in children: a report from the Pediatric Cardiac Critical Care Consortium.

Author information

1
1Department of Pediatrics,Division of Pediatric Cardiology,Medical University of South Carolina,Charleston,South Carolina,United States of America.
2
2Department of Pediatrics and Communicable Diseases,Division of Cardiology,C.S. Mott Children's Hospital,University of Michigan Medical School,Ann Arbor,Michigan,United States of America.
3
3Department of Pediatrics,Division of Pediatric Cardiology,University of Alabama at Birmingham,Birmingham,Alabama,United States of America.
4
4The Heart Institute,Cincinnati Children's Hospital Medical Center,Cincinnati,Ohio,United States of America.
5
5Department of Pediatrics,Division of Cardiology,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
6
6Department of Critical Care Medicine,Division of Cardiac Intensive Care,Children's Hospital of Pittsburgh,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania,United States of America.
7
7Department of Critical Care Medicine and Cardiology,Children's National Medical Center,Washington,District of Columbia,United States of America.
8
8Michigan Congenital Heart Outcomes Research and Discovery Unit,University of Michigan Congenital Heart Center,Ann Arbor,Michigan,United States of America.

Abstract

Introduction Chylothorax after paediatric cardiac surgery incurs significant morbidity; however, a detailed understanding that does not rely on single-centre or administrative data is lacking. We described the present clinical epidemiology of postoperative chylothorax and evaluated variation in rates among centres with a multicentre cohort of patients treated in cardiac ICU.

METHODS:

This was a retrospective cohort study using prospectively collected clinical data from the Pediatric Cardiac Critical Care Consortium registry. All postoperative paediatric cardiac surgical patients admitted from October, 2013 to September, 2015 were included. Risk factors for chylothorax and association with outcomes were evaluated using multivariable logistic or linear regression models, as appropriate, accounting for within-centre clustering using generalised estimating equations.

RESULTS:

A total of 4864 surgical hospitalisations from 15 centres were included. Chylothorax occurred in 3.8% (n=185) of hospitalisations. Case-mix-adjusted chylothorax rates varied from 1.5 to 7.6% and were not associated with centre volume. Independent risk factors for chylothorax included age <1 year, non-Caucasian race, single-ventricle physiology, extracardiac anomalies, longer cardiopulmonary bypass time, and thrombosis associated with an upper-extremity central venous line (all p<0.05). Chylothorax was associated with significantly longer duration of postoperative mechanical ventilation, cardiac ICU and hospital length of stay, and higher in-hospital mortality (all p<0.001).

CONCLUSIONS:

Chylothorax after cardiac surgery in children is associated with significant morbidity and mortality. A five-fold variation in chylothorax rates was observed across centres. Future investigations should identify centres most adept at preventing and managing chylothorax and disseminate best practices.

KEYWORDS:

CHD; Chylothorax; cardiac ICU; cardiac surgery; paediatrics

PMID:
28552079
DOI:
10.1017/S104795111700097X

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