Pharmacist-integrated early screening for postoperative complications in pediatric cardiac surgery: Evidence synthesis and derivation of the pediatric early complication score

Pharmacy Practice

  • Weerapong Chidnok1Associate Professor; Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand., 2Associate Professor; Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand, 65000.
  • Jiratchaya Wienghirun3Student trainee; Medical and Pharmaceutical Innovation Research and Development Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 65000.
  • Chaiyapat Lin3Student trainee; Medical and Pharmaceutical Innovation Research and Development Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 65000.
  • Prayuth Poowaruttanawiwit4Ph.D. Clinical Pharmacy, Associate Professor; Medical and Pharmaceutical Innovation Research and Development Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand., 5Ph.D. Clinical Pharmacy, Associate Professor; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 65000.

Volume 24 Issue 2 Pages 1-14

DOI: 10.18549/PharmPract.2026.2.3598

Abstract

Background: Early postoperative complications remain a major determinant of morbidity and mortality in pediatric cardiac surgery despite improved survival. Conventional risk systems such as Risk Adjustment for Congenital Heart Surgery (RACHS) and Risk Adjusted Surgical Complexity Hierarchy (RASCH) focus on procedural complexity and mortality rather than real-time complication prediction. Objectives: This systematic review and meta-analysis aimed to quantify the pooled incidence and predictors of early postoperative complications and to derive a concise, evidence-based Pediatric Early Complication Score (PECS) to support early screening and pharmacist-integrated care. Methods: Eligible studies enrolled patients <18 years undergoing congenital heart surgery and reported extractable complication incidences or predictor-adjusted effects. Data were pooled using random-effects meta-analysis with prespecified thresholds (e.g., cardiopulmonary bypass [CPB] ≥120 minutes, C-reactive protein [CRP] >118 mg/L). Internal validity was reinforced by preregistration, standardized definitions, duplicate assessment, adjusted-effect preference, and ROBINS-I/RoB2 risk-of-bias tools. Results: Across 13 observational studies (n≈25,000) and two randomized trials, higher operative complexity (RACHS 3–6 or RASCH-2 ≥4), prolonged CPB exposure, neonatal age (≤60 days), and elevated CRP/D-dimer were consistently associated with approximately threefold higher early-complication risk (pooled adjusted effect ≈2.8, 95% CI 2.03–3.88, I²≈23%). These reproducible predictors were transformed into integer points (4, 2, 2, 2, 1 respectively) to form the PECS, which stratifies patients into low (0–3), moderate (4–6), and high (≥7) risk tiers via a logistic probability link. Conclusions: The PECS offers a transparent, internally valid, and clinically tractable bedside tool integrating surgical complexity, CPB duration, age, and inflammatory response to predict early postoperative complications. Its pragmatic design supports pharmacist-led, prevention-focused care and warrants multicenter calibration and external validation.

Keywords

  • pediatric cardiac surgery
  • postoperative complications
  • risk prediction
  • cardiopulmonary bypass
  • clinical pharmacist
Pharmacy Practice

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