Impact of High Spinal Anesthesia in Pediatric Congenital Heart Surgery on Fast-Track Recovery: A Propensity Score-Matched Retrospective Comparative Study.
Aravinthasamy Sivamurugan, Nada Sadek, Rakesh Sondekoppam, Alex Rier, Sudhakar Subramani, Srinivasan Rajagopal, Yatish Ranganath, Arun Singhal, Satoshi Hanada
INTRODUCTION
Fast-track cardiac surgery is gaining interest in pediatric cardiac surgery because of significant benefits of early extubation to the patients and health systems.
High spinal anesthesia (HSA), while historically have been utilized in pediatric heart surgery, its impact on fast-track recovery profile has not been evaluated.
We hypothesized that “in patients who have received HSA in combination with GA, the recovery characteristics such as extubation time, length of hospital (LOS) and ICU stay (ICU) will be different in comparison to those receiving GA alone.”
METHODS
We queried our EHR and the Society of Thoracic Surgeons database (Nov 2010 till Dec 2020)
Pediatric patients < 18 years classified as Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) Class 3 or less undergoing congenital heart surgeries were included.
The cases were divided into two groups: pts who received HSA in combination with GA (HSA group) and those with GA alone without any additional neuraxial blocks (GA group).
Primary outcome was extubation rate in the operating room.
Secondary outcomes included extubation rates within 6 hours after ICU admission, length of hospital stay (LOS), length of stay in the intensive care unit (ICU), postoperative opioid consumption, pain scores and incidence of complications related to HSA.
To account for patient characteristics, patients in the HSA and GA groups were matched at a 1:1 ratio using propensity score matching (error allowance: 0.15).
The groups were compared using the Mann-Whitney U-test for continuous variables and chi-square test for dichotomous variables.
A P value <0.05 was considered statistically significant.
RESULTS
Our results show that the patients receiving High Spinal Anesthesia were more likely to be extubated in the operating room and had decreased length of ICU and hospital stay
DISCUSSION
Our study provides preliminary evidence on the impact and benefits of HSA on fast-track recovery following pediatric congenital heart surgery.
Our results show that the patients in the HSA group were more likely to be extubated in the operating room and spent less time on postoperative mechanical ventilation in addition to having a decreased stay in the ICU and hospital overall.
Future prospective well designed randomized clinical trials are warranted to verify these outcomes.
