Prolonged length of stay after surgery for adult congenital heart disease: a single-centre study in a developing country

• Published in: Cardiology in the young Vol. 30; no. 9; pp. 1253 - 1260
• Main Authors: Martins, Russell S., Dawood, Zaiba S., Memon, Muhammad K. Y., Akhtar, Saleem
• Format: Journal Article
• Language: English
• Published: Cambridge Cambridge University Press 01.09.2020
• Subjects: Aorta; Body mass; Body mass index; Body size; Cardiovascular disease; Cardiovascular diseases; Complications; Confidence intervals; Coronary artery disease; Developing countries; Heart diseases; Heart surgery; Kidneys; LDCs; Length of stay; Optimization; Patients; Surgery; Pakistan
• ISSN: 1047-9511; 1467-1107
• DOI: 10.1017/S1047951120001936

Abstract Background: With the growing number of adults requiring operations for CHD, prolonged length of stay adds an additional burden on healthcare systems, especially in developing countries. This study aimed to identify factors associated with prolonged length of stay in adult patients undergoing operations for CHD. Methods: This retrospective study included all adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011 to 2016 at a tertiary-care private hospital in Pakistan. Prolonged length of stay was defined as hospital stay >75th percentile of the overall cohort (>8 days). Results: This study included 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years. Comorbid disease was present in 59.0% of patients. Most patients underwent atrial septal defect repair (42.2%). A total of 38 (22.9%) patients had a prolonged length of stay. Post-operative complications occurred in 38.6% of patients. Multivariable analysis showed that pre-operative body mass index (odds ratio: 0.779; 95% confidence interval: 0.620–0.980), intraoperative aortic cross-clamp time (odds ratio: 1.035; 95% confidence interval: 1.009–1.062), and post-operative acute kidney injury (odds ratio: 7.392; 95% confidence interval: 1.036–52.755) were associated with prolonged length of stay. Conclusion: Predictors of prolonged length of stay include lower body mass index, longer aortic cross-clamp time, and development of post-operative acute kidney injury. Shorter operations, improved pre-operative nutritional optimisation, and timely management of post-operative complications could help prevent prolonged length of stay in patients undergoing operations for adult CHD.