What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study
Objectives Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric car...
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BMJ Publishing Group
2019-09-01
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| Online Access: | https://bmjopen.bmj.com/content/9/9/e028533.full |
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| author | Stephen Morris Serban Stoica Andrew Parry Christina Pagel Jo Wray David J Barron Karen Sheehan Kathleen Selway Lyvonne Tume Jane Cassidy Alison Jones John Stickley David Anderson Deborah Ridout Peter Davis Emma Hudson Andrew Mclean Warren Rodrigues Thomas Witter Victor T Tsang Sheryl Snowball Luke Maidment Sarah Bohannon Kate Penny-Thomas Joanne Webb Sinead Cummins Natasha Khan Teresa Dickson Ray Samson Isobel Mcleod Paul Wellman Rhian Lakhani Carrie Cherrington Rob Tulloh Bill Gaynor Rodney Franklin Lisa Allera Kate Bull Trevor Ritchens Branko Mimic Jon Smith Vibeke Hjortdal Michael Vath Tom Treasure Anne Keatley Clarke Bea Tuten |
| author_facet | Stephen Morris Serban Stoica Andrew Parry Christina Pagel Jo Wray David J Barron Karen Sheehan Kathleen Selway Lyvonne Tume Jane Cassidy Alison Jones John Stickley David Anderson Deborah Ridout Peter Davis Emma Hudson Andrew Mclean Warren Rodrigues Thomas Witter Victor T Tsang Sheryl Snowball Luke Maidment Sarah Bohannon Kate Penny-Thomas Joanne Webb Sinead Cummins Natasha Khan Teresa Dickson Ray Samson Isobel Mcleod Paul Wellman Rhian Lakhani Carrie Cherrington Rob Tulloh Bill Gaynor Rodney Franklin Lisa Allera Kate Bull Trevor Ritchens Branko Mimic Jon Smith Vibeke Hjortdal Michael Vath Tom Treasure Anne Keatley Clarke Bea Tuten |
| author_sort | Stephen Morris |
| collection | DOAJ |
| description | Objectives Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.Design The design was a prospective, multicentre, multidisciplinary mixed methods study.Setting The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.Participants Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.Results Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).Conclusions Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement. |
| format | Article |
| id | doaj-art-5bd10c3e34484e149a95b0961a6d5bcc |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
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| series | BMJ Open |
| spelling | doaj-art-5bd10c3e34484e149a95b0961a6d5bcc2025-08-20T02:07:20ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2018-028533What are the important morbidities associated with paediatric cardiac surgery? A mixed methods studyStephen Morris0Serban Stoica1Andrew Parry2Christina Pagel3Jo Wray4David J Barron5Karen Sheehan6Kathleen SelwayLyvonne Tume7Jane Cassidy8Alison Jones9John Stickley10David Anderson11Deborah Ridout12Peter Davis13Emma Hudson14Andrew Mclean15Warren Rodrigues16Thomas Witter17Victor T Tsang18Sheryl SnowballLuke MaidmentSarah BohannonKate Penny-ThomasJoanne WebbSinead CumminsNatasha KhanTeresa DicksonRay SamsonIsobel McleodPaul Wellman19Rhian LakhaniCarrie CherringtonRob TullohBill GaynorRodney Franklin20Lisa AlleraKate BullTrevor RitchensBranko MimicJon Smith21Vibeke HjortdalMichael VathTom Treasure22Anne Keatley ClarkeBea TutenUniversity of Cambridge, Cambridge, UKBristol Heart Institute, University of Bristol, Bristol, UKBristol Heart Institute, University of Bristol, Bristol, UKprofessor of operational researchCentre for Outcomes and Experience Research in Children`s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK4 Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, CanadaBristol Royal Hospital for Children, University Hospitals Bristol and Weston Foundation NHS Trust, Bristol, UKChild Health, University of Salford, Salford, Greater Manchester, UKBirmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UKPaediatric Intensive Care Unit, Birmingham Women`s and Children`s NHS Foundation Trust, Birmingham, UKPaediatric Cardiac Surgery, Birmingham Children`s Hospital, Birmingham, West Midlands, UKDepartment of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia1 University College London, London, UKPaediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UKVelindre University NHS Trust, Cardiff, UKhonorary associateGOSHEvelina London Children`s Hospital, London, UKCardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK6 Department of Paediatric Intensive Care, Evelina London Children`s Hospital, London, UKPaediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UKCardiothoracic Directorate, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKprofessor of cardiothoracic surgeryObjectives Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.Design The design was a prospective, multicentre, multidisciplinary mixed methods study.Setting The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.Participants Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.Results Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).Conclusions Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.https://bmjopen.bmj.com/content/9/9/e028533.full |
| spellingShingle | Stephen Morris Serban Stoica Andrew Parry Christina Pagel Jo Wray David J Barron Karen Sheehan Kathleen Selway Lyvonne Tume Jane Cassidy Alison Jones John Stickley David Anderson Deborah Ridout Peter Davis Emma Hudson Andrew Mclean Warren Rodrigues Thomas Witter Victor T Tsang Sheryl Snowball Luke Maidment Sarah Bohannon Kate Penny-Thomas Joanne Webb Sinead Cummins Natasha Khan Teresa Dickson Ray Samson Isobel Mcleod Paul Wellman Rhian Lakhani Carrie Cherrington Rob Tulloh Bill Gaynor Rodney Franklin Lisa Allera Kate Bull Trevor Ritchens Branko Mimic Jon Smith Vibeke Hjortdal Michael Vath Tom Treasure Anne Keatley Clarke Bea Tuten What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study BMJ Open |
| title | What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study |
| title_full | What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study |
| title_fullStr | What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study |
| title_full_unstemmed | What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study |
| title_short | What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study |
| title_sort | what are the important morbidities associated with paediatric cardiac surgery a mixed methods study |
| url | https://bmjopen.bmj.com/content/9/9/e028533.full |
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