Cardiology in the Young

Original Article

Pulmonary complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

David S. Coopera1 c1, Jeffrey P. Jacobsa1, Paul J. Chaia1, James Jaggersa2, Paul Baracha3, Robert H. Beekman IIIa4, Otto Krogmanna5 and Peter Manninga6

a1 The Congenital Heart Institute of Florida (CHIF), Divisions of Critical Care and Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Florida Pediatric Associates and Cardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America

a2 Division of Cardiovascular and Thoracic Surgery, Duke’s Children’s Hospital and Health Centre, Duke University, Durham, North Carolina, United States of America

a3 Department of Anaesthesia, University of Utrecht, Utrecht, Netherlands

a4 Division of Cardiology, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati, Cincinnati, Ohio, United States of America

a5 Paediatric Cardiology – CHD, Heart Centre Duisburg, Duisburg, Germany

a6 Division of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati, Cincinnati, Ohio, United States of America

Abstract

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the pulmonary system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of pulmonary complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Correspondence:

c1 Correspondence to: David S. Cooper, MD, MPH, The Congenital Heart Institute of Florida (CHIF), Clinical Assistant Professor of Pediatrics, University of South Florida, Florida Pediatric Associates, 880 Sixth Street South, Suite 370, St. Petersburg, FL 33701. Tel: 727 767 4375; Fax: 727 767 4951; E-mail: davidscooper@verizon.net