Risk Factors for Pericardiocentesis After Paediatric Cardiac Surgery

TL;DR

This study identifies risk factors for needing a pericardiocentesis after pediatric heart surgery, focusing on postoperative anticoagulation use.

Contribution

The study identifies postoperative anticoagulation as an independent risk factor for pericardiocentesis after pediatric cardiac surgery.

Findings

Postoperative anticoagulation use was independently associated with the need for pericardiocentesis.

Prednisone use and a history of previous pericardial effusion showed higher odds but were not statistically significant.

The type of surgical procedure was not linked to the need for drainage.

Abstract

Pericardial effusions are common after paediatric cardiac surgery and can lead to cardiac tamponade in a small minority. However, it is difficult to predict which patients with an effusion will require pericardiocentesis. Therefore, among children with a postoperative effusion, we sought to identify risk factors for requiring pericardiocentesis.

We conducted a case-control study including paediatric patients who underwent cardiac surgery between January 1, 2005, and July 1, 2020, at the Stollery Children’s Hospital. Cases were defined as those who underwent pericardiocentesis within 2 months of cardiac surgery and were compared with controls who had an effusion but did not require pericardiocentesis. Controls were matched 2:1 to cases based on age and year of surgery.

There were 42 cases and 84 controls. The median age at surgery was 3.0 years (interquartile range [IQR]: 0.5-6.4 years) among cases and 2.2 years (IQR: 0.4-5.8 years) among controls. The median weight at surgery was 13.5 kg (IQR: 6.4-18.0 kg) among cases and 13.5 kg (IQR: 4.9-23.1 kg) among controls. The use of anticoagulation or antiplatelet agents (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.5-8.2, P < 0.01) in the postoperative period was independently associated with effusions requiring drainage. The use of prednisone postoperatively (OR: 3.3, 95% CI: 0.8-14.0, P = 0.10) and a history of previous pericardial effusion (OR: 4.7, 95% CI: 0.9-25.6, P = 0.08) were associated with a higher odds of pericardiocentesis but did not reach statistical significance.

The use of postoperative anticoagulation was independently associated with the need for pericardiocentesis. Type of surgical procedure was not associated with the need for drainage.