Cardiac Biomarkers Associated With Hospital Length of Stay After Pediatric Congenital Heart Surgery

Background. Prolonged hospital length of stay after congenital heart surgery is a significant cost burden and is associated with postoperative morbidity. Our goal was to evaluate the association between pre- and postoperative biomarker levels and in-hospital length of stay for children after congenital heart surgery. Methods. We enrolled patients <18 years of age who underwent at least 1 congenital heart operation at Johns Hopkins Hospital from 2010 to 2014. Blood samples were collected before the index operation and at the end of the bypass. ST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements were evaluated as log-transformed, median, and tercile cut-points. We evaluated the association between pre- and postoperative NT-proBNP and ST2 measurements with in-hospital postoperative length of stay using multivariate logistic regression. We adjusted for covariates used in The Society of Thoracic Surgeons Congenital Heart Surgery Mortality Risk Model. Results. In our cohort 45% of our patients had an in-hospital postoperative length of stay longer than the median. Before adjustment preoperative NT-proBNP above the population median and the highest tercile exhibited a significantly longer in-hospital length of stay. After adjustment for covariates in the risk model, pre- and postoperative ST2 and NT-proBNP demonstrated a significantly longer length of stay. Conclusions. Perioperative ST2 and NT-proBNP had a significant association with increased postoperative in-hospital length of stay before and after adjustment. ST2 in particular could be used to guide an earlier assessment of patient risk for complications that may lead to adverse outcomes. (C) 2021 by The Society of Thoracic Surgeons