Risk Factors for Pericardiocentesis After Paediatric Cardiac Surgery

Background Pericardial effusions are common following pediatric cardiac surgery and can lead to cardiac tamponade in a small minority. However, it is difficult to predict which patients with an effusion will require pericardiocentesis. Therefore, among children with a postoperative effusion, we sought to identify risk factors for requiring pericardiocentesis. Methods We conducted a case-control study including pediatric patients who underwent cardiac surgery between January 1, 2005, and July 1, 2020, at the Stollery Children's Hospital. Cases were defined as those who underwent pericardiocentesis within two months of cardiac surgery and were compared to controls who had an effusion but did not require pericardiocentesis. Controls were matched 2:1 to cases based on age and year of surgery. Results There were 42 cases and 84 controls. Median age at surgery was 3.0 years (interquartile range 0.5-6.4) among cases and 2.2 years (IQR 0.4-5.8) among controls. Median weight at surgery was 13.5 kg (IQR 6.4-18.0) among cases and 13.5 kg (IQR 4.9-23.1) among controls. The use of anticoagulation or antiplatelet agents (OR 3.6, 95% CI 1.5-8.2, p <0.01) in the post-operative period was independently associated with effusions requiring drainage. The use of prednisone postoperatively (OR 3.3, 95% CI 0.8-14.0, p=0.10) and a history of previous pericardial effusion (OR 4.7, 95% CI 0.9-25.6, p=0.08) were associated with a higher odds of pericardiocentesis but did not reach statistical significance. Conclusions Use of postoperative anticoagulation was independently associated with the need for pericardiocentesis. Type of surgical procedure was not associated with the need for drainage.