Impact of Abdominal Operations on Neonatal Cardiac Surgery Outcomes

M. Faateh¹, A. Mehdizadeh-Shrifi¹, H. F.. Ahmed¹, M. Rodts², A. Misfeldt³, D. Lehenbauer¹, D. Morales⁴, A. Ashfaq¹, M. Ricci^5
1Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio ²Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Cincinnati, Ohio ³Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio ⁴Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical CenterCincinnati Children's Hospital Medical Center, Cincinnati, Ohio ⁵Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Iowa City, Ohio

Purpose: Neonates undergoing congenital heart surgery (CHS) are frequently born with gastrointestinal (GI) defects and have heightened risk of developing GI complications necessitating abdominal surgery. We sought to identify characteristics and outcomes of patients who underwent an abdominal operation during their neonatal cardiac surgery admission.

Methods: The pediatric health information system database (2004-2023) was queried to identify neonates undergoing cardiac surgery with the use of cardiopulmonary bypass. GI operations included bowel resections/anastomosis, ostomy creation (small or large intestine), hepatobiliary procedures and gastric operations (surgical feeding tube placement not included). Baseline characteristics, in-hospital outcomes and hospitalization costs (2023 USD) were compared between patients who required GI operations vs not, stratified by timing of GI surgery (pre- or post- cardiac surgery). Predictors of mortality were assessed using a multivariable logistic regression model, adjusted for age at CHS (days), sex, race/ethnicity, prematurity, birthweight, year of surgery, birth admission, congenital heart disease type, CHS complexity and ECMO use.

Results: A total of 12,357 neonates undergoing CHS were identified of which 310 (2.5%) underwent abdominal operations; 80 (0.6%) patients underwent GI surgery pre-CHS and 241 (1.9%) post-CHS. Of these, the majority of the procedures were bowel resections 110 (36%), followed by appendectomies 109 (35%) and ostomy creation 97 (31%). GI surgery patients (pre or post CHS) were more likely to be preterm and low birthweight (both p< 0.05). The median duration of GI surgery to CHS in the Pre-CHS GI surgery subgroup was 10 days (IQR 6-16) and CHS to GI surgery in post-CHS GI surgery group was 25 days (IQR 13-41). Mortality was higher in the both the pre-CHS GI (25% vs 8%) and post-CHS GI (22% vs 8%) comparisons, both p< 0.001. Similarly, length of stay, hospitalization costs and non-home discharge were all higher in the GI surgery groups. The adjusted odds of mortality were at least three times higher in both pre-CHS GI surgery (OR: 3.2, 95%CI: 1.52-6.67) and post-CHS GI surgery (OR: 3.2, 95%CI: 1.97-4.79)

Conclusion: Gastrointestinal surgery during neonatal cardiac surgery hospitalization (pre- or post- cardiac surgery) is independently associated with a >3x increased risk of mortality. Similarly, GI surgery doubles the length of stay and hospitalization costs in these patients.

Identify the source of the funding for this research project: None