Ernesto Fernandez, MD
University of Texas Health Science Center At Houston
Houston, Texas
Disclosure information not submitted.
Alvaro Coronado Munoz, MD
Pediatric Intensivist
University of Texas Health Science Center At Houston, United States
Disclosure information not submitted.
Title: Analysis of Renal Dysfunction after Cardiopulmonary Bypass Surgery in Single Ventricle Infants
Introduction: Cardiopulmonary Bypass CPB is linked with an inflammatory cascade that leads to renal dysfunction (AKI). AKI worsens patient outcomes, including mortality. Patients with AKI might require higher level of support resulting in more extensive in-patient stays. We hypothesize that post-surgical infants with single ventricle physiology and renal dysfunction would have higher mortality.
Methods: Retrospective cohort of Single Ventricle Patients less than 1 year old inpatient from the Texas DSHS repository, 2017-2019. Primary outcome was mortality, secondary outcomes were hospital charges and length of stay. Frequentist analysis and multivariate regression were performed.
Results: 2,628 patients with single ventricle physiology were identified, 414 (15.7%) had a diagnosis of AKI. Of those with AKI, 318 (76.8%) were noted to be greater than 1 month of age compared to only 96 neonates (23.2%; p< 0.001). 229 mortalities were documented (8.7%), of which 163 had a diagnosis of AKI (71.2%; p< 0.001). AKI was associated to the highest Illness Severity and Risk of Mortality scores (3M® all Patient Diagnosis Related Group scoring) (p< 0.001). Infants with Single Ventricle physiology with AKI had an adjusted odds ratio of mortality of 1.7 (95% CI 1.2-2.4; p< 0.001). We included ECMO, intraventricular hemorrhage and cardiac arrest in the model. All those covariates were associated to higher mortality. Finally, those with AKI were noted to have higher Total Charges with a mean difference of $857,766 (95% C.I. of difference of $749,602-$965,930) as well as longer Length of Stay with a mean difference of 36.7 days (95% C.I. of difference 32.3-41.1 days), p < 0.001.
Conclusions: Post CPB surgery, Infants with single ventricle physiology with a diagnosis of AKI have overall higher odds of mortality, longer length of stay, and higher total hospital charges.