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Postoperative Inhaled Nitric Oxide Does Not Decrease Length of Stay in Pediatric Cardiac Surgery Admissions

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Abstract

Pulmonary hypertension is one of the most challenging complications in congenital heart surgery. The purpose of this study was to characterize inhaled nitric oxide administration in children with and without pulmonary hypertension who underwent congenital heart surgery and to describe the effect of nitric oxide administration on admission outcomes. This is a cross-sectional study utilizing data from the Pediatric Health Information System (PHIS) and PHIS + databases from 2004 to 2015. Pediatric patients with a congenital heart disease diagnosis were included and divided into groups with pulmonary hypertension that received and not received inhaled nitric oxide and patients without diagnosis of pulmonary hypertension who received and did not receive inhaled nitric oxide. For all admissions, the following were captured: age of admission, gender, year of admission, length of stay, billed charges, inpatient mortality, the presence of specific congenital malformations of the heart, specific cardiac surgeries, and comorbidities. Comparisons between groups were completed using a Mann–Whitney-U test and Fisher’s exact test. Outcomes evaluation was completed using univariate and regression analyses. A total of 40,194 pediatric cardiac surgical admissions without pulmonary hypertension were identified. Of these, 726 (1.8%) received inhaled nitric oxide. Regression analyses demonstrated that inhaled nitric oxide was independently associated with increased length of stay, billed charges, and inpatient mortality. A total of 1678 pediatric cardiac surgical admissions with pulmonary hypertension were identified. Of these, 195 (11.6%) received inhaled nitric oxide. Regression analyses demonstrated that inhaled nitric oxide was independently associated with a significant increase in length of stay and billed charges. There was no statistically significant association between inhaled nitric oxide and decrease mortality. Administration of inhaled nitric oxide after pediatric cardiac surgery increases length of stay and billed charges while not providing improved inpatient mortality. In fact, administration of inhaled nitric oxide was associated with increased mortality in those without pulmonary hypertension while not impacting mortality in any way in those with pulmonary hypertension.

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Authors and Affiliations

  1. Division of Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA

    Joshua Wong & Rohit S. Loomba

  2. Respiratory Care & ECMO Services, Texas Children’s Hospital, Houston, TX, USA

    Lee Evey

  3. Cardiac Intensive Care Unit, Section of Critical Care and Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Ronald A. Bronicki & Saul Flores

Authors
  1. Joshua Wong
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  2. Rohit S. Loomba
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  3. Lee Evey
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  4. Ronald A. Bronicki
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  5. Saul Flores
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Correspondence to Saul Flores.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The proposed methodology follows ethical standards. Due to the deidentified and retrospective nature of the data, no inform consent was obtained.

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Wong, J., Loomba, R.S., Evey, L. et al. Postoperative Inhaled Nitric Oxide Does Not Decrease Length of Stay in Pediatric Cardiac Surgery Admissions. Pediatr Cardiol 40, 1559–1568 (2019). https://doi.org/10.1007/s00246-019-02187-z

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  • DOI: https://doi.org/10.1007/s00246-019-02187-z

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