Laparoscopy Is Safe in Infants and Neonates with Congenital Heart Disease: A National Study of 3684 Patients

摘要

Purpose: Concerns have been raised about the use of laparoscopic surgery (LS) in infants with congenital heart disease (CHD) due to their unique physiology. Prior studies on the safety and effectiveness of laparoscopy in children with CHD are limited in scope and cohort size. Materials and Methods: We identified children <1 year of age with CHD who underwent abdominal surgery in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Project Pediatric database. Patients were stratified by surgical approach: open surgery (OS) versus LS. We then compared postoperative complications, postoperative length of stay, and 30-day mortality by using multivariable regression methods. Results: In total, 3684 patients met study criteria: 2502 underwent OS while 1182 underwent LS. Infants who underwent LS were older (98 days versus 36 days), larger by weight (4.2kg versus 3.2kg), and more likely to require nutritional support preoperatively (74.7% versus 60.5%) (all P<.001). After multivariable adjustment, LS was associated with lower overall complication rate (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.34-0.52, P<.001) and shorter postoperative length of stay (effect size -1.8 days, 95% CI -1.8-1.2, P<.001). LS and OS demonstrated similar 30-day mortality (OR 0.71, 95% CI 0.38-1.32, P=.28). Conclusions: Laparoscopy can be performed safely in infants with CHD who need abdominal surgery. Although further studies may be useful in determining which infants with congenital cardiac disease benefit the most from use of laparoscopy, minimally invasive techniques can be applied to routine and complex abdominal procedures.