Modelos estatísticos para suporte a avaliação cirúrgica em crianças portadoras de cardiopatias congênitas

• Autor(a) principal: Lopes, Marina Travassos
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UFPB
• Texto Completo: https://repositorio.ufpb.br/jspui/handle/tede/9057
• topic: Cardiopatia congênita; Modelos de regressão logística; Análise de sobrevivência; Congenital heart disease; Logistic regression models; Survival analysis; CIENCIAS DA SAUDE::SAUDE COLETIVA

Heart diseases are responsible for more deaths in the first year of life than any other congenital problem in Brazil, affecting 8 to 10 children per 1000 live births. There are several types of heart diseases, some heal with time others require surgery. Evaluating the characteristics of the surgeries, it is possible to obtain the probability of the occurrence of postoperative complications and the estimation of the length of stay in the ICU (Intensive Care Unit) that varies according to the typology of this occurrence and the patient health condition. In this sense, the use of statistical models can help to optimize the care of patients in unfavorable clinical conditions. The aim of this study is to develop a tool based on statistical models to assist decision making about the chronological order of the surgeries to be performed. The data from this study came from the charts of the children destined to the execution of the surgery of congenital heart disease in the reference center that composes the Pediatric Cardiology Network PE-PB in the State of Paraíba. A logistic regression model was used to estimate the probability of occurrence of postoperative complications and survival analysis techniques to detect differences between the influence of determining factors on the length of ICU stay after the surgery. All data were analyzed in statistical software R, version 3.2.0. A total of 130 children were included, which 86.15% being below 10 years of age and weighing between 5 and 25 kg. Of the 72 children who presented post-surgical complications, 22.3% presented shunt-type cardiopathy, and 10% had Patent Ductus Arteriosus, followed by 9.2% with Tetralogy of Fallot. The risk factors identified by logistic regression as more associated with the outcome "developing post-surgical complications" were: high risk score (OR = 12.9; p-value = 0.02), presence of acyanotic obstructive heart disease (OR = 12.5, p-value = 0.006), the aortic clamping time during surgery greater than 20 minutes (OR = 3.3; p-value = 0.01), the time of extubation during the surgery (OR = 1.1, p-value = 0.07), presence of pulmonary arterial hypertension (OR = 6.7, p-value = 0.09) and age less than 6 months (OR = 3, 6; p-value = 0.05). In the survival analysis, it was possible to verify that there are statistically significant differences in length of ICU stay between children less than 6 months and older children; Also among children who presented high surgical risk and those who did not present; And among children where there is presence or absence of pulmonary arterial hypertension, in which the presence of some of these characteristics implies a greater probability of permanence for a certain time in the ICU. Also through the survival analysis, it was possible to observe that besides the factors identified through the logistic regression, the occurrence of postoperative infection in children also entails a longer hospitalization time after the surgery. Both techniques analyzed together, were able to build estimates for a certain hospital stay in cases of occurrence or not of postoperative complications, bringing support to hospital planning decisions, resulting in the optimization of the rotation of the available beds, in addition to the suggestion of chronological order of the queue of the next surgeries of congenital cardiopathy to be performed.