DeWitt et al evaluated pediatric patients who underwent surgery for congenital heart disease. They identified risk factors for mortality as well as prolonged ICU care. The authors are from Children's Hospital of Philadelphia, University of Utah, Texas Children's Hospital, Emory University, University of Toronto and University of Michigan.
Patient selection: surgery for congenital heart disease. Neonates were 4 to 11 days old. Nonneonates were 5 to 93 months old.
General risk factors:
(1) age < 6 months
(2) non-cardiac birth defect
(3) preoperative length of stay > 1 day
(4) STAT (Society of Thoracic Surgeons European Association for Cardio-Thoracic Surgery) score
(5) delayed initiation of enteral feeds
(6) chylothorax or pleural effusion
(7) deep surgical site infection (SSI)
(8) any other infection
Additional risk factors for a neonate: none
Additional risk factors for non-neonates:
(1) preoperative intubation
(2) previous cardiac surgery
(3) surgery required circulatory arrest
(4) use of vasoactive agents
(5) diaphragm paralyzed
(6) stroke
The risk of prolonged critical illness increases with the number and severity of the risk factors.
