Impact of diaphragmatic paralysis after cardiothoracic surgery in children

Objectives: We sought to determine the prevalence and clinical impact of di aphragmatic paralysis caused by phrenic nerve injury after cardiothoracic s urgery in children. Methods: A search of cardiology, radiology, and hospita l databases identified 170 episodes of diaphragmatic paralysis after cardio thoracic surgery in 168 children operated on from 1985 to 1997, Medical rec ords were reviewed to determine demographics, details of the operation and postoperative course, diagnostic features and management of diaphragmatic p aralysis, and follow-up status. Results: The prevalence of diaphragmatic pa ralysis was 1.6% (95% confidence interval 1.4%-1.8%), Median age at operati on was 6 months (range <1 day-14.4 years). Median time from the operation t o the initial investigation was 5 days (range <1 day-61 days), with 57% of patients receiving mechanical ventilation at diagnosis. Diaphragmatic plica tion was performed in 40% of the patients at a median interval from the ini tial investigation of 15 days (range 3 days-11.1 months). Significant indep endent factors associated with increased postoperative hospital stay were l ower patient weight at operation, previous cardiothoracic operations, bilat eral diaphragmatic paralysis, increased interval from operation to investig ation, mechanical ventilation at the time of investigation, and diaphragmat ic plication. Confirmed recovery of diaphragmatic function was noted before hospital discharge in only 15 episodes. Conclusions: Diaphragmatic paralys is complicating cardiothoracic surgery continues to occur in the current er a, with a significant impact on morbidity, Smaller patients with bilateral hemidiaphragmatic paralysis, requiring mechanical ventilation, may represen t a higher rise subgroup to target for increased diagnostic suspicion and m ore aggressive management; early spontaneous recovery is rare.