Early extubation is associated with improved outcomes after complete surgical repair of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries in pediatric patients

Yinan Li; Yuan Jia; Hongbai Wang; Xie Wu; Shoujun Li; Fuxia Yan; Su Yuan

doi:10.1186/s13019-021-01416-y

Early extubation is associated with improved outcomes after complete surgical repair of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries in pediatric patients

J Cardiothorac Surg. 2021 Mar 19;16(1):31. doi: 10.1186/s13019-021-01416-y.

Authors

Yinan Li¹, Yuan Jia¹, Hongbai Wang¹, Xie Wu¹, Shoujun Li², Fuxia Yan¹, Su Yuan³

Affiliations

¹ Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
² Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
³ Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China. lyn920919@hotmail.com.

Abstract

Background: The aim of this study was to investigate the impact of an early extubation strategy on outcomes following complete repair of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery.

Methods: One hundred thirteen patients undergoing complete repair surgery of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery between 2016 and 2018 were included in our retrospective propensity-score matched study. Propensity score matching was conducted in 1 to 2 ratio to balance the covariables impacting on clinical outcomes between groups. The primary outcomes were defined as length of intensive care unit stay, postoperative length of hospital stay and in-hospital medical cost. The secondary outcomes included postoperative complications such as re-intubation, re-exploration, in-hospital mortality, arrhythmia and etc.. In addition, blood product consumption were also abstracted.

Results: Compared with matched controls, patients in the early extubation group were demonstrated with a significant reduced length of intensive care unit stay (Median: 1.9 d νs. 4.1 d, p = 0.039), postoperative length of hospital stay (Median: 9.0 d νs. 17.0 d, p = 0.007) and in-hospital medical cost (Median: 69.5 × 1000CNY νs. 113.6× 1000CNY, p = 0.041). As for the postoperative complications, the occurrence of re-intubation, re-exploration, in-hospital mortality, arrhythmia and renal replacement therapy was similar between groups. However, pulmonary complications (p = 0.049) were with a significantly lower rate in the early extubation group. In addition, fresh frozen plasma (p = 0.041) transfusion volume were significantly reduced in the early extubation group rather than packed red blood cells and platelets.

Conclusions: Early extubation following complete repair of pulmonary atresia improved clinical outcomes and reduced in-hospital medical cost without increasing any postoperative complications.

Keywords: Early extubation; Medical cost; Multistage rehabilitation; Pulmonary atresia; Ventricular septal defect.

MeSH terms

Airway Extubation / methods*
Child, Preschool
China / epidemiology
Female
Follow-Up Studies
Heart Septal Defects / mortality
Heart Septal Defects / surgery*
Hospital Mortality / trends
Humans
Incidence
Length of Stay / trends
Male
Postoperative Complications / epidemiology*
Postoperative Complications / prevention & control
Pulmonary Atresia / mortality
Pulmonary Atresia / surgery*
Retrospective Studies
Time Factors

Supplementary concepts

Pulmonary Atresia With Ventricular Septal Defect