Background: Postoperative care is a very important part of patient recovery. Pulmonary complications are the major cause of morbidity and mortality after cardiac surgery especially in children due to lung immaturity and small respiratory reserve. The reported incidence in our center ranges from 68-76% in younger age group (≤6 years old). This study aims to determine the incidence and predictors of postoperative pulmonary complications in children ≤6 years of age with congenital heart disease undergoing cardiac surgery. If modifiable predictors would be identified early on, postoperative pulmonary complications after cardiothoracic surgery would be significantly reduced.
Methods: Prospective cohort including congenital heart disease patients ≤6years old who underwent cardiac surgery. Data collected were demographic details including preoperative, intraoperative, and postoperative risk factors of postoperative pulmonary complications and pulmonary complications observed. Factors associated with postoperative pulmonary complications were determined and tested using logistic regression analysis.
Results: Study population consisted of 79 children with mean age of 40 months. There were 49 (62%) males and 30 (38%) females. 41 (52%) cases of acyanotic and 38 (48%) cases of cyanotic heart disease. Among the risk factors tested, nutritional status using the subjective global nutritional assessment (SGNA) (p=0.002), presence of respiratory infection within two weeks prior to the surgery (p=0.016), degree of hypoxemia in arterial blood gas (p=0.041), pulmonary artery pressure of more than 40 mmHg (p=0.007), and bypass time of more than two hours (p=0.003) were identified to be predictors of postoperative pulmonary complications. A significant incidence of postoperative pulmonary complications in this study was 54.2%.
Conclusion: Nutrition status using SGNA, recent respiratory tract infection (<2 weeks), degree of hypoxemia (p02 < 40 mmHg), pulmonary artery pressure (>40 mmHg), and bypass time (>2 hours) were the identified predictors of postoperative pulmonary complications. Of these, nutritional status and respiratory infection are the risk factors modifiable preoperatively, where maximizing nutritional status and delaying surgery after a bout of respiratory infection would decrease risk of postoperative pulmonary complications.