Postoperative Fever and Major Infections after
Pediatric Cardiac Surgery
Chodchanok Vijarnsorn MD*, Gornmiga Winijkul MD**,
Duangmanee Laohaprasitiporn MD*, Paweena Chungsomprasong MD*, Prakul Chanthong MD*,
Kritvikrom Durongpisitkul MD*, Jarupim Soonswang MD*, Apichart Nana MD*,
Thaworn Subtaweesin MD***, Somchai Sriyoschati MD***, Julaporn Pooliam MSc****
Affiliation :
* Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
** Division of Ambulatory and Toxicology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
*** Division of Cardio Vascular Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
**** Research and Statistics Consultant, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
Objective : 1) to identify the current status of major infections and other etiologies of postoperative fever from pediatric
cardiac surgery, 2) to determine the risk factors of major infections.
Material and Method: Databases of pediatric cardiac surgery patients in 2005 were retrospectively reviewed. The main
outcomes of interest were postoperative fever and its etiologies. Potential predictors were analyzed by comparing patients
who developed or did not have infections.
Results : Two hundred thirty patients, 43% (n = 99) developed postoperative fever. Major infections occurred in 13.5%
(n = 31), and postpericardiotomy syndrome (PPS) was seen in 8.7% (n = 20) of the patients. The infection rate was 16.9/100
procedures, including pneumonia (29 episodes) and blood stream infection (6 episodes). Risk factors were infancy, prolonged
ventilator support > 2 days, hospital length of stay (LOS) > 14 days, intensive care unit (ICU) LOS > 3 days, re-open
procedure, and extubation failure rate. Conversely, cyanosis and high complexity operations were not associated. Positive
erythrocyte sedimentation rate was related to infections or to PPS (the area under the ROC = 0.72).
Conclusion : Following pediatric cardiac surgery, major infections are still problematic. The risks increase with infancy,
prolonged ventilator support, prolonged hospital and ICU LOS, re-open procedure, and extubation failure.
Keywords : Heart defects, Congenital, Postoperative complications, Cross infections, Postpericardiotomy syndrome
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