Complications After Cardiac Operations: All Are Not Created Equal

Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Suarez‐Pierre, Alejandro; Sciortino, Christopher M.; Mandal, Kaushik; Zehr, Kenton J.; Conte, John V.; Higgins, Robert S.D.; Cameron, Duke E.; Whitman, Glenn

doi:10.1016/j.athoracsur.2016.10.022

Cited by 75 publications

(73 citation statements)

References 22 publications

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“…Postoperative stroke, renal failure, and cardiac arrest have been independently associated with operative mortality, regardless of prolonged ventilation. Previous work emphasized the linear relationship between operative mortality and the number of postoperative complications experienced by comparing failure‐to‐rescue rates between those who experienced single versus multiple major complications . A relatively low (2.2%) failure‐to‐rescue rate was noted in patients who only experienced prolonged ventilation; however, this rate was significantly higher when patients also had a stroke (23%), unplanned reoperation (26%), or renal failure (53%).…”

Section: Discussionmentioning

confidence: 99%

“…Our previous findings along with the present study provide a better understanding of patient outcomes in the setting of prolonged ventilation. These may guide clinical decisions, ongoing risk‐assessment, and allocation of resources …”

Section: Discussionmentioning

confidence: 99%

“…These may guide clinical decisions, ongoing risk-assessment, and allocation of resources. 30 The discrepancy between a validated and well-accepted pre-…”

Section: Duration Of Ventilationmentioning

confidence: 99%

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Predictors of operative mortality among cardiac surgery patients with prolonged ventilation

et al. 2019

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Background Prolonged ventilation after cardiac surgery affects survival and increases morbidity. Previous studies have focused on predicting this complication preoperatively; however, indicators of poor outcome in those requiring prolonged ventilation remain ill‐defined. We sought to identify predictors of operative mortality in cardiac surgery patients who experience prolonged mechanical ventilation. Methods 1698 patients who underwent cardiac surgery (CAB, aortic valve replacement ± CAB, or mitral valve repair/replacement ± CAB) required prolonged postoperative mechanical ventilation (>24 hours) between 2012 to 2016 in a statewide consortium. Perioperative factors were evaluated to identify the association with operative mortality. Covariates were selected through bootstrap aggregation to fit multivariable logistic regression models. The relative strength of association was determined by the Wald chi‐square statistic. Results Median patient age was 68 years [IQR 61 to 76], 38% (644/1,698) were female, median duration of mechanical ventilation was 65 hours [IQR 38 to 143], median STS predicted risk of mortality was 3.1% [IQR 1.4 to 6.9%], and 15.7% (266/1698) suffered operative mortality. Among preoperative and operative characteristics, patient age and intraoperative initiation of extracorporeal membrane oxygenation (ECMO) were the strongest correlates of operative mortality on the multivariate analysis. Among postoperative factors, cardiac arrest and renal failure requiring dialysis were the strongest predictors of risk‐adjusted operative mortality. Type of operation or surgical center had no association to mortality after risk adjustment. Conclusion Prolonged ventilation following cardiac surgery is associated with a five‐fold increase in operative mortality. In these patients, operative mortality is associated with older age, intraoperative initiation of ECMO, postoperative cardiac arrest, and renal failure requiring dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of operative mortality among cardiac surgery patients with prolonged ventilation

et al. 2019

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“…Furthermore, interactions between some major complications can increase the risks of adverse postoperative outcomes. 5,6 In this study, not taking these factors into account in the statistical analysis may be a main reason for these surprising results. Thus, we believe that the results of this study would have been more conclusive and informative if the additive interactions of major complications on postoperative mortality had been assessed by using the relative excess risk due to interaction, as performed in previous studies.…”

Section: Associations Of Gastrointestinal Complications and Adverse Omentioning

confidence: 74%

Associations of Gastrointestinal Complications and Adverse Outcomes After Cardiac Surgery

Liu

Xue

Yang

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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“…For instance, there is a body of literature that outlines with each additional complication the likelihood of mortality increases exponentially. [2][3][4] As such, clinicians should look at the microsimulation results as more thought provoking than fact. Another weakness of this study was the decision to exclude studies with a minority of patients aged less than 65 years.…”

mentioning

confidence: 99%

Commentary: Bioprosthetic aortic valve replacement: A high standard of comparison for transcatheter aortic valve implantation

Martin

Yamashita

2019

The Journal of Thoracic and Cardiovascular Surgery

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Complications After Cardiac Operations: All Are Not Created Equal

Cited by 75 publications

References 22 publications

Predictors of operative mortality among cardiac surgery patients with prolonged ventilation

Predictors of operative mortality among cardiac surgery patients with prolonged ventilation

Associations of Gastrointestinal Complications and Adverse Outcomes After Cardiac Surgery

Commentary: Bioprosthetic aortic valve replacement: A high standard of comparison for transcatheter aortic valve implantation

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