Risk factors of prolonged recovery after Fontan operation

作     者：王晗 张崇健 罗丹东 朱卫中 曾嵘 熊卫萍 陈寄梅 庄建 

作者机构：Department of Cardiac Surgery Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences 

出 版 物：《South China Journal of Cardiology》 (岭南心血管病杂志（英文版）)

年 卷 期：2015年第16卷第4期

页      面：201-207页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：supported by National Key Technology Research and Development Program of China(No.2011BAI11B22) Natural Science Foundation of Guangdong Province(No.2014A030311041) Science and Technology Pro-gram of Guangzhou(No.201508020107) 

主　　题：Fontan, risk factors acute kidney injury cohort study 

摘      要：Background With low rates of mortality and morbidity, Fontan procedure has become the preferred approach for patients with univentricular heart disease. However, risk factors associated with prolonged postoperative recovery still remain uncertain. Methods Data on all patients admitted to the surgical intensive care unit （SICU） after a Fontan procedure from Jan 2010 to December 2014 were retrospectively analyzed. We excluded all patients who were expired. The study cohort was further divided into a prolonged recovery group that includ- ed patients with 〉75% ile for duration of SICU stay and mechanical ventilation, and a normal recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic and physiological variables between the prolonged and normal recovery groups. Results There were 164 Fon- tan operations performed and 159 patients in the study cohort. Groups were similar in demographic characteris- tics, preoperative hemodynamic parameters, and operative and immediate postoperative managements. A Fenes- trated Fontan procedure was present in 133 （83.6%）. The external Fontan procedure was present in 124 （78.0%）. Within the study population, 41 （25.8%） patients met criteria for prolonged recovery. Univariate risk factors for prolonged recovery included acute kidney injury （AKI, P=0.001）, preoperative prothrombin time and internation- al normalized ratio （P=0.02 and 0.018）, immediate postoperative red blood cell （RBC）, hematocrit, neutrophil and platelet （P=0.019, 0.006, 0.019, and 0.043）, and postoperative nosocomial infection, incision infection, blood urea nitrogen, and creatinine （P=0.011, 0.016, 0.014, and 0.005）. In a multivariable model, the independent risk factors for prolonged recovery after the Fontan operation were postoperative AKI （OR 1.753, 95% CI 1.238, 2.484） and postoperative higher RBC （OR 1.667, 95% CI 1.110, 2.503）. Fenestrated procedure might be a protec- tive factor （OR 0.355, 95% CI