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

Published online by Cambridge University Press:  29 May 2017

Jason R. Buckley ,
Eric M. Graham ,
Michael Gaies ,
Jeffrey A. Alten ,
David S. Cooper ,
John M. Costello ,
Yuliya Domnina ,
Darren Klugman ,
Sara K. Pasquali  and
Janet E. Donohue
...Show all authors
Jason R. Buckley*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Eric M. Graham
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Michael Gaies
Affiliation:
Department 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
Jeffrey A. Alten
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
David S. Cooper
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
John M. Costello
Affiliation:
Department 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
Yuliya Domnina
Affiliation:
Department 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
Darren Klugman
Affiliation:
Department of Critical Care Medicine and Cardiology, Children’s National Medical Center, Washington, District of Columbia, United States of America
Sara K. Pasquali
Affiliation:
Department 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
Janet E. Donohue
Affiliation:
Michigan Congenital Heart Outcomes Research and Discovery Unit, University of Michigan Congenital Heart Center, Ann Arbor, Michigan, United States of America
Wenying Zhang
Affiliation:
Michigan Congenital Heart Outcomes Research and Discovery Unit, University of Michigan Congenital Heart Center, Ann Arbor, Michigan, United States of America
Mark A. Scheurer
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
*
Correspondence to: J. R. Buckley, MD, 601 Children’s Hospital, 165 Ashley Avenue MSC915, Charleston, SC 29425, United States of America. Tel: +843 792 9146; Fax: +843 792 5878; E-mail: [email protected]
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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

Chylothoraxcardiac ICUcardiac surgerypaediatricsCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1678 - 1685
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Copyright
© Cambridge University Press 2017 

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References

1. Zuluaga, MT. Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr 2012; 24: 291–294.Google Scholar
2. Chan, EH, Russell, JL, Williams, WG, Van Arsdell, GS, Coles, JG, McCrindle, BW. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 1864–1870.Google Scholar
3. Mery, CM, Moffett, BS, Khan, MS, et al. Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 2014; 147: 678–686.e1; discussion 85–86.Google Scholar
4. Biewer, ES, Zurn, C, Arnold, R, et al. Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet. J Cardiothorac Surg 2010; 5: 127.Google Scholar
5. Allen, EM, van Heeckeren, DW, Spector, ML, Blumer, JL. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg 1991; 26: 1169–1174.Google Scholar
6. McCulloch, MA, Conaway, MR, Haizlip, JA, Buck, ML, Bovbjerg, VE, Hoke, TR. Postoperative chylothorax development is associated with increased incidence and risk profile for central venous thromboses. Pediatr Cardiol 2008; 29: 556–561.Google Scholar
7. Beghetti, M, La Scala, G, Belli, D, Bugmann, P, Kalangos, A, Le Coultre, E. Etiology and management of pediatric chylothorax. J Pediatr 2000; 136: 653–658.Google Scholar
8. Bauman, ME, Moher, C, Bruce, AK, Kuhle, S, Kaur, S, Massicotte, MP. Chylothorax in children with congenital heart disease: incidence of thrombosis. Thromb Res 2013; 132: e83–e85.Google Scholar
9. Cormack, BE, Wilson, NJ, Finucane, K, West, TM. Use of Monogen for pediatric postoperative chylothorax. Ann Thorac Surg 2004; 77: 301–305.Google Scholar
10. Milonakis, M, Chatzis, AC, Giannopoulos, NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369–373.Google Scholar
11. White, SC, Seckeler, MD, McCulloch, MA, Buck, ML, Hoke, TR, Haizlip, JA. Patients with single ventricle anatomy may respond better to octreotide therapy for chylothorax after congenital heart surgery. J Card Surg 2014; 29: 259–264.CrossRefGoogle ScholarPubMed
12. Borasino, S, Diaz, F, El Masri, K, Dabal, RJ, Alten, JA. Central venous lines are a risk factor for chylothorax in infants after cardiac surgery. World J Pediatr Congenit Heart Surg 2014; 5: 522–526.Google Scholar
13. Pasquali, SK, Peterson, ED, Jacobs, JP, et al. Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment for pediatric cardiac operations. Ann Thorac Surg 2013; 95: 197–203.Google Scholar
14. Pasquali, SK, He, X, Jacobs, JP, et al. Measuring hospital performance in congenital heart surgery: aministrative versus clinical registry data. Ann Thorac Surg 2015; 99: 932–938.Google Scholar
15. Gaies, M, Cooper, DS, Tabbutt, S, et al. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 2015; 25: 951–957.Google Scholar
16. Gaies, M, Donohue, JE, Willis, GM, et al. Data integrity of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Cardiol Young 2016; 26: 1090–1096.Google Scholar
17. Centers for Disease Control. Retrieved October 14, 2015, from http://www.cdc.gov/growthcharts/.Google Scholar
18. Jacobs, JP, Jacobs, ML, Maruszewski, B, et al. Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardiothorac Surg 2012; 42: 775–779.Google Scholar
19. O’Brien, SM, Jacobs, JP, Pasquali, SK, et al. The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model: part 1-statistical methodology. Ann Thorac Surg 2015; 100: 1054–1062.Google Scholar
20. Dori, Y, Keller, MS, Fogel, MA, et al. MRI of lymphatic abnormalities after functional single-ventricle palliation surgery. Am J Roentgenol 2014; 203: 426–431.Google Scholar
21. Dori, Y, Keller, MS, Rychik, J, Itkin, M. Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient. Pediatrics 2014; 134: e590–e595.Google Scholar
22. Rusin, CG, Acosta, SI, Sheckerdemian, LS, et al. Prediction of imminent, severe deterioration of children with parallel circulations using real-time processing of physiologic data. J Thorac Cardiovasc Surg 2016; 152: 171–177.Google Scholar