Predictors of operative mortality among cardiac surgery patients with prolonged ventilation

Abstract

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.

Postoperative Prolonged Mechanical Ventilation in Patients With Newly Diagnosed Glioblastoma—An Unrecognized Prognostic Factor

“…PMV was defined as prolonged postoperative invasive ventilation for more than 24 h, as recently indicated (8).…”

Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation

“…2 Nephrology, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil. 3 Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.…”

“…Coronary artery bypass grafting (CABG) is indicated as a treatment of ischemic heart disease for patients with chronic kidney disease [1] (CKD), a population with a high mortality rate. Respiratory failure is common during the postoperative period following CABG and continues to be a major cause of morbidity in this population [2,3]. Mechanical ventilation in the postoperative period is needed until normothermia and hemodynamic stability is achieved [4].…”

Complicaciones respiratorias en el posoperatorio de cirugía cardíaca

“…En un estudio retrospectivo entre 2008 y 2012 en unidades de terapia intensiva de Andalucía, sobre 3.588 ingresos encontraron una incidencia de 11,6%, asociada a 44,3% de mortalidad, fundamentalmente por disfunción orgánica múltiple y sepsis, comparado con 3,1% de mortalidad en pacientes extubados dentro de las 24 horas (35) . Se asocia con edad avanzada, PCR posoperatorio y falla renal con terapia de remplazo, quintuplicando la mortalidad (36) .…”

“…La continua mejora de los procedimientos quirúrgicos y de cuidados críticos los vuelve obsoletos en pocos años. Los indicadores están más vinculados a complicaciones surgidas durante el proceso que a evaluaciones de potenciales patologías previas (36) . No se deben usar para determinar conductas sino para identificar y estratificar grupos de riesgo donde el control de la optimización ventilatoria y la completa preparación para la desvinculación debe ser extremada.…”