Risk factors for prolonged intensive care unit stay after pediatric cardiac surgery: data from national center for cardiovascular diseases in China

After pediatric cardiac surgery, many patients require a prolonged stay in the intensive care unit. These patients require tremendous resources, which adds an additional burden to the healthcare systems. To date, few studies have investigated risk factors in pediatric patients with congenital heart disease, especially in developing countries. This study aimed to explore the risk factors for prolonged intensive care unit stay after pediatric cardiac surgery to improve care planning and resource management. This retrospective study included pediatric patients with congenital heart disease who underwent surgical repair at our single center from January 2021 to December 2022. We analyzed 44 potential risk factors across pre-operative, intra-operative, and post-operative variables using logistic regression to identify independent risk factors. Prolonged intensive care unit stay was defined as ≥95th percentile (≥12 d). Of the 4348 patients studied, 246 experienced prolonged intensive care unit stay or hospital death after surgery were categorized as Group 1, while 4102 patients without prolonged stay or hospital death after surgery were designated as Group 2. Multivariable analysis identified 14 independent risk factors: age, pre-operative data cystatin C, palliative procedure, duration of cardiopulmonary bypass, lactic acid at weaning from cardiopulmonary bypass, postoperative arrhythmia, renal replacement therapy, re-operation, cardiopulmonary resuscitation, re-intubation, central venous pressure 2 h after transferred to the intensive care unit, volume of chest tube drainage 2 h after transferred to the intensive care unit, vasoactive-inotropic score on post-operative day 1, left ventricular ejection fraction on post-operative day 1. This study identified 14 risk factors associated with prolonged intensive care unit stays after pediatric cardiac surgery. These findings can help identify at-risk patients for targeted interventions to reduce intensive care unit duration and associated costs.