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Cited by 135Congenital Heart Disease StudiesCardiac and Coronary Surgery TechniquesCardiovascular Conditions and Treatments

Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery: Analysis of the Pediatric Health Information Systems Database

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Pasquali, Sara K., Hall, Matthew, Li, Jennifer S., Peterson, Eric D., Jaggers, James, Lodge, Andrew J., Marino, Bradley S., Goodman, Denise M. +1 more·2010·Circulation
DOI 10.1161/circulationaha.110.948737PMC PMC3013053
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Abstract

Background—: Children undergoing congenital heart surgery often receive corticosteroids with the aim of reducing the inflammatory response after cardiopulmonary bypass; however, the value of this approach is unclear. Methods and Results—: The Pediatric Health Information Systems Database was used to evaluate outcomes associated with corticosteroids in children (0 to 18 years of age) undergoing congenital heart surgery at 38 US centers from 2003 to 2008. Propensity scores were constructed to account for potential confounders: age, sex, race, prematurity, genetic syndrome, type of surgery (Risk Adjustment in Congenital Heart Surgery [RACHS-1] category), center, and center volume. Multivariable analysis, adjusting for propensity score and individual covariates, was performed to evaluate in-hospital mortality, postoperative length of stay, duration of ventilation, infection, and use of insulin. A total of 46 730 children were included; 54% received corticosteroids. In multivariable analysis, there was no difference in mortality among corticosteroid recipients and nonrecipients (odds ratio, 1.13; 95% confidence interval, 0.98 to 1.30). Corticosteroids were associated with longer length of stay (least square mean difference, 2.18 days; 95% confidence interval, 1.62 to 2.74 days), greater infection (odds ratio, 1.27; 95% confidence interval, 1.10 to 1.46), and greater use of insulin (odds ratio, 2.45; 95% confidence interval, 2.24 to 2.67). There was no difference in duration of ventilation. In analysis stratified by RACHS-1 category, no significant benefit was seen in any group, and the association of corticosteroids with increased morbidity was most prominent in RACHS-1 categories 1 through 3. Conclusion—: In this observational analysis of children undergoing congenital heart surgery, we were unable to demonstrate a significant benefit associated with corticosteroids and found that corticosteroids may be associated with increased morbidity, particularly in lower-risk patients.

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  • Administration of high-dose glucocorticoids may be associated with increased morbidity.

    “In addition, the administration of high dose glucocorticoids may be associated with increased morbidity [23-25].”

    From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [25]

    The Discussion reports that corticosteroids may be associated with increased morbidity, particularly in lower-risk children undergoing congenital heart surgery. But the Discussion also says the study could not assess corticosteroid dose, so it does not establish the claim specifically for high-dose glucocorticoids. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Multi-center data analysis has not demonstrated a mortality benefit with the use of perioperative steroids but rather an increase in postoperative morbidity.

    “Multi-center data analysis has not demonstrated a mortality benefit with the use of perioperative steroids but rather an increase in postoperative morbidity [25].”

    From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [25]

    The Discussion reports no demonstrated mortality benefit and an association between corticosteroid use and increased postoperative morbidity, particularly in lower-risk children. The claim omits the paper’s qualification that corticosteroids *may be associated* with increased morbidity; this observational analysis does not establish that they caused the increase. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Authors
Pasquali, S. K., Hall, M., Li, J. S., Peterson, E. D., Jaggers, J., Lodge, A. J., Marino, B. S., Goodman, D. M., & Shah, S. S.
Affiliations
  • Northwestern University (US)
  • From the Divisions of Pediatric Cardiology (S.K.P., J.S.L.), Cardiothoracic Surgery (J.J., A.J.L.), and Cardiology (E.D.P.), Departments of Pediatrics, Surgery, and Medicine, Duke University Medical Center, and Duke Clinical Research Institute (S.K.P., J.S.L., E.D.P.), Durham, NC; Child Health Corporation of America, Shawnee Mission, Kan (M.H.); Divisions of Cardiology and Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (B.S.M.); Division of...
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-11-23
Volume
122
Issue
21
Pages
2123-2130
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.110.948737
PMC
PMC3013053
OpenAlex
W2122620245
Cited by
135
References
1
Citations by year
2026: 3 · 2025: 6 · 2024: 3 · 2023: 7 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 8 · 2018: 12 · 2017: 17 · 2016: 13 · 2015: 15 · 2014: 9 · 2013: 14 · 2012: 9
FWCI
7.47
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (K08HL103631)
  • National Institute of Allergy and Infectious Diseases (K01AI073729, K01-AI-73729)
  • National Center for Research Resources (KL2RR024127)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
Keywords
corticosteroids, congenital heart surgery, pediatric cardiac surgery, cardiopulmonary bypass, inflammation, in-hospital mortality, postoperative hospital stay, postoperative infection, insulin use, surgical outcomes
MeSH terms
Adolescent, Adrenal Cortex Hormones, Cardiopulmonary Bypass, Child, Child, Preschool, Combined Modality Therapy, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Morbidity, Retrospective Studies, Risk Factors, United States, Databases, Factual, Treatment Outcome

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