Risk factors for early secondary infections after cardiopulmonary bypass in children with congenital heart disease: a single-center analysis of 265 cases.

Background: Infections after cardiopulmonary bypass (CPB) represent a significant challenge in pediatric patients with congenital heart disease (CHD), impacting the length of hospital stay, treatment costs, and clinical outcomes. The present study aimed to investigate the risk factors associated with early secondary infections after CPB in CHD children, thereby providing a theoretical foundation for enhancing clinical strategies to prevent and manage postoperative secondary infections.

Methods: Clinical data of CHD children who underwent open-heart surgery with CPB at the First Affiliated Hospital of Guangxi Medical University between July 2020 and June 2023 were retrospectively analyzed. Patients were categorized into infected and non-infected groups based on the occurrence of secondary infections within one week following surgery.

Results: A total of 265 CHD children undergoing open-heart surgery under CPB during the period from July 2020 to June 2023 were enrolled in this study, including 118 children (44.5%) in the infected group and 147 (55.5%) in the non-infected group. Six children (2.3%) either abandoned treatment or died postoperatively, all of whom were from the infected group. The median interval from the completion of surgery to the diagnosis of infection was 17.0 hours [interquartile range (IQR), 12.0-21.5 hours]. The infection types included lung infection alone (n=88, 74.6%), pulmonary infection complicated by sepsis (n=26, 22.0%), sepsis alone (n=3, 2.5%), and pulmonary infection complicated by urinary tract infection (n=1, 0.8%). Multivariate logistic regression analysis revealed that younger surgical age [odds ratio (OR) =0.979, 95% confidence interval (CI): 0.970-0.987], higher preoperative New York Heart Association (NYHA) class (OR =1.874, 95% CI: 1.088-3.229), preoperative pulmonary hypertension (severe: OR =32.887, 95% CI: 6.105-177.157; moderate: OR =9.582, 95% CI: 3.950-23.245; and mild: OR =18.541, 95% CI: 6.667-51.559), American Society of Anesthesiologists (ASA) class ≥3 (OR =2.166, 95% CI: 1.093-4.290), longer operative time (OR =1.007, 95% CI: 1.001-1.012), and extended duration of aortic cross-clamping (ACC; OR =1.017, 95% CI: 1.008-1.026) were independent risk factors for early postoperative infections in children undergoing surgery with CPB for CHD.

Conclusions: Younger surgical age, higher preoperative NYHA class, severe preoperative pulmonary hypertension, ASA grade ≥3, prolonged ACC and operative time are independent risk factors for the development of early secondary infections in CHD children after CPB.