Abstract
BACKGROUND: Postoperative infections are major complications in pediatric congenital heart disease (CHD) patients and are associated with prolonged ICU stays, increased mechanical ventilation times, and extended hospitalizations. This study aims to investigate the prevalence, clinical outcomes, and associated risk factors for postoperative infections in pediatric CHD patients. METHODS: This retrospective study included 1,131 pediatric CHD patients who underwent surgery at Xinhua Hospital, affiliated to Shanghai Jiao Tong University, between October 2020 and July 2024. Based on clinical manifestations and microbiological evidence, patients were stratified into four groups: non-infected (n = 1000), possible infection (n = 45), probable infection (n = 40), and confirmed infection (n = 46). Statistical analyses were performed using Mann-Whitney U tests and multivariable logistic regression models, adjusting for multiple confounding factors, including gender, age, weight, cyanotic heart disease, pulmonary hypertension, and surgical complexity (STAT score), to assess the association between infection status and hospitalization duration, ICU stay, and mechanical ventilation time. RESULTS: Infections occurred in 11.6% of patients and were independently associated with prolonged hospitalization (adjusted OR = 3.10, 95% CI: 1.84-5.20), ICU stay (adjusted OR = 3.51, 95% CI: 2.01-6.12), and mechanical ventilation (adjusted OR = 1.85, 95% CI: 1.09-3.11). Other independent predictors of prolonged stay included cyanotic lesions, pulmonary hypertension, and STAT score. Among suspected and confirmed infection patients, multidrug-resistant organism infection (+ 11.54 days), delayed pathogen sampling (≥ postoperative day 4; +6.71 days), prematurity (+ 29.00 days), and high STAT score (+ 4.05 days) were significantly associated with extended hospitalization. CONCLUSIONS: Postoperative infections are significantly associated with prolonged hospitalization and indices of delayed recovery in pediatric CHD patients, particularly in cases involving multidrug-resistant organisms, delayed pathogen sampling, high STAT categories, and prematurity. Early detection and targeted infection control measures may be associated with improved outcomes in this high-risk population. Future research should focus on multicenter prospective studies and advanced diagnostic tools to enable timely and effective infection management. CLINICAL TRIAL NUMBER: Not applicable.