Risk factors associated with prolonged postoperative intensive care unit stay in total anomalous pulmonary venous connection

Objective: Prolonged intensive care unit stay occupies medical resources and increases medical cost. The present study aimed to identify the risk factors associated with prolonged postoperative intensive care unit (ICU) stay in total anomalous pulmonary venous connection (TAPVC). Methods The medical records of 85 patients who underwent TAPVC correction surgery were retrospectively analyzed. Patients were divided into the prolonged stay group and the standard stay group. The prolonged stay group included all the patients exceeding the 75th percentile for duration of ICU stay, and the standard stay group included all the remaining patient. The effect of patient variables on the ICU stay duration was investigated using univariate analysis and logistic regression analysis. Results The median age of 85 patients was 41 (18–103) days, median weight was 3.80 (3.30–5.35) kg. According to the grouping criteria, the postoperative duration of ICU stay in prolonged stay group (n = 23) was 11–68 days and the postoperative duration of ICU stay in standard stay group (n = 62) was 2–10 days. Preoperative lower saturation of pulse oximetry (SpO 2 ), intraoperative higher plasma lactate level and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When the preoperative SpO 2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 hours, the risk of prolonged ICU stay was increased. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency operation, long anesthesia time, low SpO 2 after anesthesia induction, long cardiopulmonary bypass (CPB) time and aortic clamp time, high level lactate, low temperature and large volume of ultrafiltration during CPB, large amount chest drainage, large red blood cells (RBCs) and plasma transfusion, postoperative cardiac dysfunction might be associated with prolonged ICU stay. Conclusions Preoperative lower SpO 2 , intraoperative higher plasma lactate level and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When the SpO 2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 hours, the risk of prolonged ICU stay was increased. Improved clinical management including early diagnosis and timely surgical intervention to reduce hypoxia time, intraoperative cardiac function protection, etc. can help to reduce ICU stay time.