Incidence and Factors Associated with Neurological Complications Following Pediatric Heart Surgery: A Retrospective Study

TL;DR

This study found that nearly 10% of children had neurological complications after heart surgery, which were linked to longer ICU stays and higher mortality.

Contribution

The study provides insights into the incidence and risk factors for neurological complications in a pediatric cardiac surgery population.

Findings

Postoperative neurological complications occurred in 9.5% of pediatric patients.

Neurological complications were associated with prolonged ICU stay and in-hospital mortality.

Longer cardiopulmonary bypass duration was linked to adverse outcomes.

Abstract

Background/Objectives: Neurological complications remain a critical source of morbidity and mortality following pediatric cardiac surgery for congenital heart disease (CHD). While advances in surgical and perioperative care have improved survival, the incidence of postoperative neurological events and their associations with perioperative characteristics remain incompletely characterized in heterogeneous pediatric populations. This study aimed to assess the incidence of postoperative neurological complications and to examine factors associated with adverse clinical outcomes in pediatric patients undergoing cardiovascular surgery. Methods: This retrospective, single-center study included 210 pediatric patients (<18 years) who underwent open-heart or major cardiovascular surgery with cardiopulmonary bypass at Medipol University Hospital between January 2021 and January 2022. Univariable logistic regression analyses were performed to explore associations between perioperative variables, postoperative neurological complications, and in-hospital mortality. Results: Of the study population, 119 patients (56.7%) were male and 91 (43.3%) were female; 117 patients (55.7%) were younger than 2 years of age. The most common procedures included ventricular septal defect repair (18.6%) and tetralogy of Fallot repair (13.3%). Postoperative neurological complications occurred in 20 patients (9.5%). Median postoperative intubation duration and intensive care unit (ICU) stay were significantly longer among patients with neurological complications (p < 0.001). In-hospital mortality occurred in 18 patients (8.6%). Postoperative neurological complications, reoperation, prolonged intubation, extended ICU stay, and longer cardiopulmonary bypass duration were significantly associated with in-hospital mortality. Conclusions: Postoperative neurological complications were associated with prolonged ICU stay and increased in-hospital mortality. These findings emphasize the clinical importance of close neurological monitoring and perioperative strategies aimed at preserving cerebral perfusion and minimizing cardiopulmonary bypass duration in pediatric cardiac surgery.