Risk factors analysis of adverse events after cardiac surgery in children with respiratory virus infection including SARS-CoV-2

To explore the risk factors associated with adverse events following cardiac surgery in children with respiratory virus infections. The innovation particularly focuses on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, symptomatic infections, and the necessity of waiting for negative test results prior to surgery. A single-center, retrospective analysis was conducted on pediatric patients with congenital heart disease who underwent surgical treatment between 2021 and 2022. Patients with positive respiratory viral nucleic acid test results before the operation were included. Patients who did not have corresponding Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) scores were excluded from the study. The patients were categorized into two groups based on the occurrence of postoperative adverse events: Group 1, which experienced adverse events (including secondary respiratory bacterial/fungal infections, reintubation, tracheotomy, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation assistance, and death), and Group 2, which did not experience any adverse events. The two groups were compared across various parameters, including age, weight, gender, STAT scores, cardiopulmonary bypass surgery, palliative surgery, residual cardiac/multisystem malformations, SARS-CoV-2 infection, symptomatic infection, and persistent positive viral detection before surgery. Multivariate analysis was performed using logistic regression. A total of 216 patients were included in the study, with 55 patients in Group 1 and 161 patients in Group 2. Through multivariate analysis, age (odds ratio (OR) 0.975, 95% confidence interval (CI) 0.956–0.995, P = 0.013) and symptomatic respiratory virus infection (OR 4.068, 95% CI 1.898–8.720, P <0.001) were identified as risk factors for adverse events after cardiac surgery in children with respiratory virus infections. The results of the receiver operating characteristic curve analysis indicated that age <12 months combined with symptomatic respiratory virus infection could predict postoperative adverse events with an area under the curve of 0.801, sensitivity of 0.845, and specificity of 0.655. Age <12 months and symptomatic respiratory viral infections (both traditional respiratory viruses and SARS-CoV-2) were risk factors for adverse events after cardiac surgery in children with respiratory viral infection. Persistent positive viral detection before surgery was not found to be an independent risk factor for adverse events.