The relationship between post-operative complications and children’s quality of life: a mediation analysis to explore the role of family factors

Objective
To explore whether post-operative morbidities after pediatric cardiac surgery affected children’s health related quality of life (HRQOL) at six months, through potentially modifiable parental psychological factors.
Design
We undertook a mediation analysis, to explore the causal pathway, based on data from a prospective, case-matched cohort study of children undergoing cardiac surgery.
Setting
Five centers in the U.K.

Interventions
No intervention.

Measurements
Cases of morbidity were identified early after pediatric cardiac surgery and matched controls with no morbidities were identified at discharge. Four mediators were assessed at six weeks after surgery, using the PedsQL Family Impact Module (Parent HRQOL and Family Function) and the PHQ-4 (Anxiety and Depression). The study outcome of child HRQOL was assessed at six months with the PedsQL.
Results
Of 666 children, 408 (65% of those surviving) contributed to the primary outcome. Children who had extracorporeal life support (ECLS) (n=11) (PConclusions
Parental HRQOL at six weeks after surgery contributes to child HRQOL at six months, amongst those with the severest types of morbidity, and as such should be a target for future interventions.