Refractory Chylothorax: Descriptive Analysis and Predictive Model in Children with Postoperative Chylothorax

Chylothorax following pediatric cardiac surgery increases morbidity and mortality. The clinical outcomes of patients with chylothorax with prolonged drainage compared to prompt resolution have not been described. This is a retrospective cohort study across eight United States pediatric cardiac intensive care units (ICU). Patients < 18 years old treated for chylothorax within 30 days of cardiac surgery were included, excluding Fontan palliations. Patients with chest tube duration >= 14 days were classified as long chylothorax (LC) vs. < 14 days as short chylothorax (SC). Univariable and multivariable logistic regression modeled patient characteristics associated with LC vs. SC. 134 patients had chylothorax, and 51 (38%) were LC. The proportion of LC increased with surgical complexity. LC was diagnosed later and had longer duration of mechanical ventilation, and ICU and hospital lengths of stay. In-hospital mortality was not different between groups. On POD 7, chest tube output (CTO, ml/kg) difference between LC and SC was greatest, with an area under the receiver operating characteristic curve of 0.76 for CTO predicting chylothorax. By multivariable analysis, clinical events associated with LC were sepsis or CLABSI (adjusted odds ratio (aOR) 8.8), postoperative open sternum (aOR 3.3), and CTO > 20 ml/kg on POD 7 (aOR 7.3). High chest tube output on POD 7 may predict LC in children post-cardiac surgery. LC is associated with increased resource utilization and morbidity. Early identification of patients at risk for LC may allow for tailored treatment strategies and improved outcomes.