Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and Risk Factors for Pericardial Effusions Requiring Readmission After Pediatric Cardiac Surgery

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Pericardial effusion (PE) may require readmission after cardiac surgery and has been associated with postoperative morbidity and mortality. We sought to identify the prevalence and risk factors for postoperative PE requiring readmission in children. A retrospective analysis of the Pediatric Health Information System database was performed between January 1, 2003, and September 30, 2014. All patients ≤18 years old who underwent cardiac surgery were identified by ICD-9 codes. Those readmitted within 1 year with an ICD-9 code for PE were identified. Logistic regression analysis was performed to determine risk factors for PE readmissions. Of the 142,633 surgical admissions, 1535 (1.1%) were readmitted with PE. In multivariable analysis, older age at the initial surgical admission [odds ratio (OR) 1.17, p < 0.001], trisomy 21 (OR 1.24, p = 0.015), geographic region (OR 1.33–1.48, p ≤ 0.001), and specific surgical procedures [heart transplant (OR 1.82, p < 0.001), systemic-pulmonary artery shunt (OR 2.23, p < 0.001), and atrial septal defect surgical repair (OR 1.34, p < 0.001)] were independent risk factors for readmission with PE. Of readmitted patients, 44.2% underwent an interventional PE procedure. Factors associated with interventions included shorter length of stay (LOS) for the initial surgical admission (OR 0.85, p = 0.008), longer LOS for the readmission (OR 1.37, p < 0.001), and atrial septal defect surgery (OR 1.40, p = 0.005). In this administrative database of children undergoing cardiac surgery, readmissions for PE occurred after 1.1% of cardiac surgery admissions. The risk factors identified for readmissions and interventions may allow for improved risk stratification, family counseling, and earlier recognition of PE for children undergoing cardiac surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

PE:

Pericardial effusion

PPS:

Postpericardiotomy syndrome

PHIS:

Pediatric Health Information System

ICD-9:

International classification of diseases, ninth revision

LOS:

Length of stay

RACHS:

Risk adjustment for congenital heart surgery

IQR:

Interquartile range

PDA:

Patent ductus arteriosus

ASD:

Atrial septal defect

VSD:

Ventricular septal defect

EP:

Electrophysiology

OR:

Odds ratio

BT:

Blalock–Taussig

ToF:

Tetralogy of Fallot

AVC:

Atrioventricular canal

TGA:

Transposition of the great arteries

TAPVR:

Total anomalous pulmonary venous return

M:

Months

D:

Days

References

  1. Lehto J, Gunn J, Karjalainen P, Airaksinen J, Kiviniemi T (2015) Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: the Finland postpericardiotomy syndrome study. J Thorac Cardiovasc Surg 149:1324–1329

    Article  PubMed  Google Scholar 

  2. Soloff LA, Zatuchui J, Janton OH et al (1953) Reactivation of rheumatic fever following mitral commissurotomy. Circulation 8:481–493

    Article  CAS  PubMed  Google Scholar 

  3. DeScheerder I, Wulfrank D, Van Renterghem L et al (1984) Association of anti-heart antibodies and circulating immune complexes in the postpericardiotomy syndrome. Clin Exp Immunol 57:423–428

    CAS  Google Scholar 

  4. Jones DA, Radford DJ, Pohlner PG (2001) Outcome following surgical closure of a secundum atrial septal defect. J Paediatr Child Health 37:274–277

    Article  CAS  PubMed  Google Scholar 

  5. Miller RH, Horneffer PJ, Gardner TJ et al (1998) The epidemiology of the postpericardiotomy syndrome: a common complication of cardiac surgery. Am Heart J 116:1323–1329

    Article  Google Scholar 

  6. Imazio M, Brucato A, Rovere ME et al (2011) Contemporary features, risk factors, and prognosis of the postpericardiotomy syndrome. Am J Cardiol 108:1183–1187

    Article  PubMed  Google Scholar 

  7. Heching HJ, Bacha EA, Liberman L (2015) Post-pericardiotomy syndrome in pediatric patients following surgical closure of secundum atrial septal defects: incidence and risk factors. Pediatr Cardiol 36:498–502

    Article  PubMed  Google Scholar 

  8. Sevuk U, Baysal E, Altindag R et al (2015) Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery. Vasc Health Risk Manag 11:373–378

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gill PJ, Forbes K, Coe JY (2009) The effect of short-term prophylactic acetylsalicylic acid on the incidence of postpericardiotomy syndrome after surgical closure of atrial septal defects. Pediatr Cardiol 30:1061–1067

    Article  PubMed  Google Scholar 

  10. Finkelstein Y, Shemesh J, Mahlab K et al (2002) Colchicine for the prevention of postpericardiotomy syndrome. Herz 27:791–794

    Article  PubMed  Google Scholar 

  11. Imazio M, Brucato A, Rovere ME et al (2011) Colchicine prevents early postoperative pericardial and pleural effusions. Am Heart J 162:527–532

    Article  CAS  PubMed  Google Scholar 

  12. Cheung EW, Sa Ho, Tang KK et al (2003) Pericardial effusion after open heart surgery for congenital heart disease. Heart 89:780–783

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Yip SB, Chau MC, Chow WH et al (1997) Pericardial effusion in adults undergoing surgical repair of atrial septal defects. Am J Cardiol 79:1706–1708

    Article  CAS  PubMed  Google Scholar 

  14. Prabhu AS, Ross RD, Heinert MR, Walters HL, Hakimi M (1996) Decreased incidence of postoperative pericardial effusions after cardiac surgery for congenital heart disease. Am J Cardiol 77(9):774–776

    Article  CAS  PubMed  Google Scholar 

  15. Dalili M, Zamani H, Aarabi-Moghaddam M (2012) Pericardial effusion after pediatric cardiac surgeries: a single center observation. Res Cardiovasc Med 1:28–32

    Article  PubMed  PubMed Central  Google Scholar 

  16. Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer RC (1984) The incidence and natural history of pericardial effusion after cardiac surgery—an echocardiographic study. Circulation 69:506–511

    Article  CAS  PubMed  Google Scholar 

  17. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR (2002) Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg 74:1148–1153

    Article  PubMed  Google Scholar 

  18. Clapp SK, Garson A Jr, Gutgesell HP, Cooley DA, McNamara DG (1980) Postoperative pericardial effusion and its relation to postpericardiotomy syndrome. Pediatrics 66:585–588

    CAS  PubMed  Google Scholar 

  19. Sevuk U, Baysal E, Altindag R et al (2016) Role of methylprednisolone in the prevention of postpericardiotomy syndrome after cardiac surgery. Eur Rev Med Pharmacol Sci 20:514–519

    CAS  PubMed  Google Scholar 

  20. Cantinotti M, Spadoni I, Assanta N et al (2014) Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age. J Cardiovasc Med 15(12):847–854

    Article  Google Scholar 

  21. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118

    Article  PubMed  Google Scholar 

  22. Lehto J, Kiviniemi TO, Gunn J et al (2016) Occurrence of postpericardiotomy syndrome admissions: a population-based registry study. Ann Med 48:28–33

    Article  PubMed  Google Scholar 

  23. Timmis GC, Gordon S, Ramos RG (1971) Recurrent postpericardiotomy syndrome. Its protracted nature and association with atrial septal defects. Mich Med 70:539–542

    CAS  PubMed  Google Scholar 

  24. Alraies MC, Jaroudi WA, Shabrang C, Yarmohammadi H, Klein AL, Tamarappoo BK (2014) Clinical features associated with adverse events in patients with postpericardiotomy syndrome following cardiac surgery. Am J Cardiol 114(9):1426–1430

    Article  PubMed  PubMed Central  Google Scholar 

  25. Concolino D, Pascuzzi A, Pietragalla E, Lia R, Strisciuglio P, Canepa S (2005) High prevalence of isolated pericardial effusion in Down Syndrome. Am J Med Genet 132A:331–332

    Article  CAS  PubMed  Google Scholar 

  26. Hirashima C, Eguchi Y, Kohmura Y, Minakami H, Sato I (2000) Isolated pericardial effusion and transient abnormal myelopoiesis in a fetus with Down’s Syndrome. J Obstet Gynaecol Res 26:303–306

    Article  CAS  PubMed  Google Scholar 

  27. Cilberto GR, Anjos MC, Gronda E et al (1995) Significance of pericardial effusion after heart transplantation. Am J Cardiol 76:297–300

    Article  Google Scholar 

  28. Hauptman PJ, Couper GS, Aranki SF, Kartashov A, Mudge GH, Loh E (1994) Pericardial effusions after cardiac transplantation. J Am Coll Cardiol 23:1625–1629

    Article  CAS  PubMed  Google Scholar 

  29. Cabalka AK, Rosenblatt HM, Towbin JA et al (1995) Postpericardiotomy syndrome in pediatric heart transplant recipients. Immunologic characteristics. Tex Heart Inst J 22(2):170–176

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Dogan OF, Duman U, Karagoz T, Ozkutlu S, Ersoy U (2005) Diagnosis of perigraft seroma formation by use of echocardiography after modified Blalock–Taussig shunt. Eur J Echocardiogr 6:385–387

    Article  PubMed  Google Scholar 

  31. Garcia-Guerata L, Burgueros M, Borches D, Gonzalez V, Jimenez J (1997) Cardiac tamponade after a systemic-pulmonary shunt complicated by serous leakage. Ann Thorac Surg 63:248–250

    Article  Google Scholar 

  32. Just H, Mattingly TW (1968) Interatrial septal defect and pericardial disease: coincidence or causal relationship? Am Heart J 76(2):157–167

    Article  CAS  PubMed  Google Scholar 

  33. Mott AR, Fraser CD, Kusnoor AV et al (2001) The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass. J Am Coll Cardiol 37:1700–1706

    Article  CAS  PubMed  Google Scholar 

  34. Wilson NJ, Webber SA, Pettersen MW et al (1994) Double-blind placebo-controlled trial of corticosteroids in children with postpericardiotomy syndrome. Pediatr Cardiol 15:62–65

    CAS  PubMed  Google Scholar 

  35. Hofneffer PJ, Miller RH, Pearson TA et al (1990) The effective treatment of postpericardiotomy syndrome after cardiac operations. A randomized placebo-controlled trial. J Thorac Cardiovasc Surg 100:292–296

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA

    Matthew D. Elias, Andrew C. Glatz, Matthew J. O’Connor, Susan Schachtner, Chitra Ravishankar & Meryl S. Cohen

  2. Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Christoper E. Mascio

Authors
  1. Matthew D. Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew C. Glatz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Schachtner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chitra Ravishankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoper E. Mascio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Meryl S. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew D. Elias.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elias, M.D., Glatz, A.C., O’Connor, M.J. et al. Prevalence and Risk Factors for Pericardial Effusions Requiring Readmission After Pediatric Cardiac Surgery. Pediatr Cardiol 38, 484–494 (2017). https://doi.org/10.1007/s00246-016-1540-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-016-1540-2

Keywords

Search

Navigation