Preoperative Nomogram and Risk Calculator for Postoperative Hypoxemia and Related Clinical Outcomes Following Stanford Type A Acute Aortic Dissection Surgery

Sheng, Weiyong; Shen, Le; Song, Yu; Du, Yifan; Wu, Jia; Tang, Chuanbin; Wang, Hongfei; Chen, Xing; Wang, Su; Luo, Jingjing; Li, Rui; Xia, Jiahong; Huang, Xintang; Wei, Long; Du, Xiaona; Wang, Dashuai

doi:10.3389/fcvm.2022.851447

Cited by 12 publications

(18 citation statements)

References 31 publications

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“…The presence of renal insufficiency, the serum levels of globulin, and surgical types were also identified to associate with the development of SH after HVS in our analysis, which was in agreement with some previous reports in other surgeries ( 3 , 7 , 8 ). Ge et al reported that patients undergoing surgery for type A aortic dissection had a 4.5-fold increased risk of postoperative hypoxemia compared to type B aortic dissection ( 8 ).…”

Section: Discussionsupporting

confidence: 92%

“…Three-quarters of the operations were isolated valve surgery, 13% had concomitant coronary artery bypass grafting (CABG), 11% had concomitant aortic surgery, and 2% had concomitant CABG as well as aortic surgery. The median durations of CPB and aortic cross clamp were respectively 108 (86, 139) and 72 (54, 95) min, and the volume of transfused RBC was 1 ( 1 , 3 ) units. The incidence rate of SH was 1.2% in isolated valve surgery, 2.7% in concomitant CABG, 7.0% in concomitant aortic surgery, and 20.6% in concomitant CABG and aortic surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Weiss and Rady et al reported that emergency surgery correlated significantly with time to extubation and lung injury, and was independent predictor of early postoperative pulmonary dysfunction ( 27 , 28 ). Previous studies have identified the close relationship between renal insufficiency and various postoperative complications after cardiovascular surgery, such as hypoxemia, pneumonia, hyperlactatemia, and tracheostomy ( 3 , 29 – 33 ). Although the related researches on the relationship between renal insufficiency and hypoxemia are limited and the exact mechanisms remain to be further investigated, we guess that inflammatory responses, erythropoietin production by the kidney, and the subsequent oxygen delivery may be involved ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…Studies focused on severe hypoxemia (SH) have been conducted in various surgical procedures, especially in acute aortic dissection surgery due to the ultrahigh prevalence ( 1 , 4 , 5 , 7 , 8 ). Some independent risk factors for postoperative SH have been identified and several prediction models have been constructed in previous studies ( 3 , 4 , 8 , 9 ). However, most of these previous studies were based on small sample sizes and lacked statistical power, which may limit the clinical utility.…”

Section: Introductionmentioning

confidence: 99%

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Nomogram and risk calculator for severe hypoxemia after heart valve surgery

Ding

Cheng²,

Sun³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHypoxemia is a very common issue in patients undergoing heart valve surgery (HVS), related to poor clinical outcomes. However, studies on severe hypoxemia (SH) after HVS have not been reported. The aims of this study were to identify predictors for SH in patients undergoing HVS and to develop and validate a risk prediction model.MethodsPatients undergoing HVS between 2016 and 2019 in a cardiovascular center were enrolled and were assigned to training and validation sets by a 7:3 ratio. Based on whether patients developed SH, they were divided into two groups. By univariate and multivariate analysis, predictors for SH were identified. Based on the predictors and logistic rule, a nomogram and a risk calculator were generated. The model was evaluated using calibration, discrimination and clinical utility.ResultsThe incidence rates of SH, moderate hypoxemia and mild hypoxemia were respectively 2.4, 23.9, and 58.2%. By multivariate analysis, seven independent risk factors for SH after HVS were identified, including body mass index, chronic obstructive pulmonary disease, renal insufficiency, white blood cell count, serum globulin, cardiopulmonary bypass time, and surgical types. The logistic model demonstrated satisfactory discrimination, calibration and clinical utility in both the training and validation sets. A nomogram and a risk calculator based on the logistic model were generated for easy application. Risk stratification was performed and three risk intervals were defined according to the nomogram and clinical practice. In addition, compared to patients without SH, patients with SH had significantly poorer clinical outcomes.ConclusionsPostoperative hypoxemia was prevalent after HVS, related to poor clinical outcomes. A logistic model including seven independent predictors for SH after HVS were established and validated, which demonstrated satisfactory discrimination, calibration and clinical utility. The results of this study may provide help to individualized risk assessment, early prevention and perioperative management.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nomogram and risk calculator for severe hypoxemia after heart valve surgery

Ding

Cheng²,

Sun³

et al. 2022

Front. Cardiovasc. Med.

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“…Additionally, several other predictors for postoperative hypoxemia have also been reported previously in the literature but were not found to be significant when analyzed by the multivariate analysis in the current study, such as advanced age, hypertension, smoking history, renal insufficiency, female sex, poor cardiac function, and diabetes ( 1 , 23 , 24 , 43 , 44 ). Some postoperative factors have also been reported to be related to the occurrence of postoperative hypoxemia, but we did not include postoperative factors into our analysis due to these factors were not available early.…”

Section: Discussionsupporting

confidence: 56%

Incidence, Risk Factors, and Outcomes of Severe Hypoxemia After Cardiac Surgery

Wang

Ding

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHypoxemia is common in patients undergoing cardiac surgery, however, few studies about severe hypoxemia (SH) after cardiac surgery exist. The objectives of this study were to clarify the incidence, risk factors, and outcomes of SH after cardiac surgery.MethodsPatients undergoing cardiac surgery from 2016 to 2019 in a single center were enrolled and were divided into two groups based on whether postoperative SH developed. Independent risk factors for SH were identified by univariate and multivariate analysis. Model selection statistics were applied to help determine the most parsimonious final model.ResultsSevere hypoxemia developed in 222 of the 5,323 included patients (4.2%), was associated with poorer clinical outcomes. Six independent risk factors for SH after cardiac surgery were identified by multivariate analysis, such as surgical types, white blood cell (WBC) count, body mass index (BMI), serum albumin, cardiopulmonary bypass (CPB) time, and intraoperative transfusion of red blood cells (RBCs). After comprehensively considering the discrimination, calibration, and simplicity, the most appropriate and parsimonious model was finally established using four predictors, such as WBC count, BMI, CPB time, and intraoperative transfusion of RBCs. A nomogram and a web-based risk calculator based on the final model were constructed to facilitate clinical practice. Patients were stratified into three risk groups based on the nomogram and clinical practice.ConclusionSevere hypoxemia was common after cardiac surgery and was associated with poorer clinical outcomes. A parsimonious final model with good discrimination, calibration, and clinical utility was constructed, which may be helpful for personalized risk assessment and targeted intervention.

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