We sought to examine potential associations between pediatric postcardiac surgical hematocrit values and postoperative complications or mortality.
METHODS:
A retrospective, cross-sectional study from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and Congenital Cardiac Anesthesia Society Database Module (2014–2019) was completed. Multivariable logistic regression models, adjusting for covariates in the STS-CHSD mortality risk model, were used to assess the relationship between postoperative hematocrit and the primary outcomes of operative mortality or any major complication. Hematocrit was assessed as a continuous variable using linear splines to account for nonlinear relationships with outcomes. Operations after which the oxygen saturation is typically observed to be <92% were classified as cyanotic and ≥92% as acyanotic.
RESULTS:
In total, 27,462 index operations were included, with 4909 (17.9%) being cyanotic and 22,553 (82.1%) acyanotic. For cyanotic patients, each 5% incremental increase in hematocrit over 42% was associated with a 1.31-fold (95% confidence interval [CI], 1.10-1.55; P = .003) increase in the odds of operative mortality and a 1.22-fold (95% CI, 1.10-1.36; P < .001) increase in the odds of a major complication. For acyanotic patients, each 5% incremental increase in hematocrit >38% was associated with a 1.45-fold (95% CI, 1.28-1.65; P < .001) increase in the odds of operative mortality and a 1.21-fold (95% CI, 1.14-1.29; P < .001) increase in the odds of a major complication.
CONCLUSIONS:
High hematocrit on arrival to the intensive care unit (ICU) is associated with increased operative mortality and major complications in pediatric patients following cardiac surgery.
See Article, p 1074
KEY POINTS
- Question: Is high postoperative hematocrit associated with worse outcomes in pediatric cardiac surgical patients?
- Findings: High hematocrit on arrival to intensive care unit (ICU) is associated with increased postcardiac surgical risk in pediatric patients.
- Meaning: Extremely high hematocrit targets have generally been favored in congenital cardiac surgery, but concerns remain about the association between high hematocrits and the association with morbidity and mortality in pediatric postcardiac surgical patients.
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