Abstract 19823: Predictors of Post Cardiac Surgery Rehabilitation Therapy in Congenital Heart Disease Patients

IntroductionCongenital heart disease (CHD) patients are at risk of motor, cognitive, speech and feeding difficulties after cardiac surgery. Rehabilitation therapy (RT) can decrease the post-surgical functional morbidity. Our goal was to describe predictors of RT in CHD patients.HypothesisPalliative surgery patients have greater RT needs.MethodsThis is a retrospective cohort study on CHD patients < 18 years repaired on cardiopulmonary bypass (CPB) at our center from 01/01/2013 to 01/31/2015. Demographic; pre, intra and postoperative; and RT (physical, occupational, speech, feeding therapy and neurodevelopment intervention) data were collected. Case complexity was determined by STS/EACTS mortality categories (STAT) and residual lesions by Technical Performance Score (TPS). Primary outcome was need for RT, primary predictor was full vs. palliative repair. Multivariable model determined the association between RT and pre and intraoperative predictors.ResultsOf 1415 subjects, 253(17.9%) had palliative repairs. Median age at surgery was 1.6(IQR 0.3, 6.1) years, 627(44.3 %) were males, 226(16%) were neonates, 116(8.2%) were premature, 292(20.6%) had a genetic syndrome. STAT category was ≥ 3 in 536(37.9%), TPS was 3 (major residua) in 136(9.6%) subjects, mean CPB time was 126.1(±65.1) minutes.A total of 586(41%) subjects required RT after surgery, with 180/226(79.6%) neonates requiring RT, feeding therapy 130/226(57.5%) was the most common. On multivariable analysis, palliative repair, prematurity, neonates, genetic syndrome, higher STAT category, class 3 TPS and longer CPB were associated with need for RT.ConclusionsPost CHD surgery RT needs are high, with nearly half the patients needing some form of therapy. Age, preterm birth, genetic syndrome, prolonged pre-surgical hospital stay, case complexity, type of repair, and presence of residua predict the need for RT, thus aiding decision making on resource allocation for appropriate RT.