Early postoperative weight-based fluid accumulation is associated with worse outcomes after neonatal cardiac surgery
Presented By:
Katie Brandewie, MD; David Bailly, DO; Priya Bhat, MD, MS; John W Diddle, MD; Muhammad Ghbeis, MD; Catherine Krawczeski, MD; Kenneth Mah, MD, MS; Tara Neumayr, MD; Tia Raymond, MD; Garrett Reichle, MS; David Selewski, MD; Huaiyu Zang, PhD; Jeffrey Alten, MD
Cincinnati Children's Hospital Medical Center
katiebrandewie@gmail.comOverview:
Objectives: Evaluate the association of postoperative day (POD) 2 weight-based fluid balance (FB-W) >10% with outcomes after neonatal cardiac surgery.
Design: Retrospective cohort study.
Setting: 22 hospitals in the NEonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) registry from September 2015 to January 2018.
Patients: Consecutive neonates (<30 days) undergoing index cardiac operation with/without cardiopulmonary bypass (CPB).
Interventions: None.
Measurements and Main Results: Of 2240 eligible patients, only 997 neonates (CPB n=658, non-CPB n=339) were weighed on POD2 and included in this analysis. Forty-five percent (n=444) of patients had FB-W >10%. In bivariable analysis, patients with POD2 FB-W >10% had higher acuity of illness, more resource utilization and worse outcomes. Hospital mortality was 2.8% (n=28) and not independently associated with POD2 FB-W >10% (OR 1.04, 95% CI 0.29-3.68). POD2 FB-W >10% was associated with all utilization outcomes, including duration of mechanical ventilation (multiplicative rate of 1.19, 95% CI 1.04-1.36), respiratory support (1.28, 95% CI 1.07-1.54), inotropic support (1.38, 95% CI 1.10-1.73), and postoperative hospital length of stay (1.15, 95% CI 1.03-1.27). In secondary analyses, POD2 FB-W as a continuous variable also demonstrated association with prolonged durations of all utilization outcomes, including duration of mechanical ventilation (OR 1.04, 95% CI 1.02-1.06], respiratory support (1.03, 95% CI 1.01-1.05), inotropic support (1.03, 95% CI 1.00-1.05), and postoperative hospital length of stay (1.02, 95% CI 1.00-1.04). POD2 intake-output based fluid balance (FB-IO) was not associated with any outcome.
Conclusions: POD2 weight-based fluid balance >10% occurs frequently after neonatal cardiac surgery and is associated with longer cardiorespiratory support and postoperative hospital length of stay. However, POD2 FB-IO was not associated with clinical outcomes. Initiatives to prevent and mitigate early postoperative fluid accumulation could provide opportunities to improve outcomes, but would require efforts to increase the proportion of neonates safely weighed in the early postoperative period.
Design: Retrospective cohort study.
Setting: 22 hospitals in the NEonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) registry from September 2015 to January 2018.
Patients: Consecutive neonates (<30 days) undergoing index cardiac operation with/without cardiopulmonary bypass (CPB).
Interventions: None.
Measurements and Main Results: Of 2240 eligible patients, only 997 neonates (CPB n=658, non-CPB n=339) were weighed on POD2 and included in this analysis. Forty-five percent (n=444) of patients had FB-W >10%. In bivariable analysis, patients with POD2 FB-W >10% had higher acuity of illness, more resource utilization and worse outcomes. Hospital mortality was 2.8% (n=28) and not independently associated with POD2 FB-W >10% (OR 1.04, 95% CI 0.29-3.68). POD2 FB-W >10% was associated with all utilization outcomes, including duration of mechanical ventilation (multiplicative rate of 1.19, 95% CI 1.04-1.36), respiratory support (1.28, 95% CI 1.07-1.54), inotropic support (1.38, 95% CI 1.10-1.73), and postoperative hospital length of stay (1.15, 95% CI 1.03-1.27). In secondary analyses, POD2 FB-W as a continuous variable also demonstrated association with prolonged durations of all utilization outcomes, including duration of mechanical ventilation (OR 1.04, 95% CI 1.02-1.06], respiratory support (1.03, 95% CI 1.01-1.05), inotropic support (1.03, 95% CI 1.00-1.05), and postoperative hospital length of stay (1.02, 95% CI 1.00-1.04). POD2 intake-output based fluid balance (FB-IO) was not associated with any outcome.
Conclusions: POD2 weight-based fluid balance >10% occurs frequently after neonatal cardiac surgery and is associated with longer cardiorespiratory support and postoperative hospital length of stay. However, POD2 FB-IO was not associated with clinical outcomes. Initiatives to prevent and mitigate early postoperative fluid accumulation could provide opportunities to improve outcomes, but would require efforts to increase the proportion of neonates safely weighed in the early postoperative period.
