Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery

Abstract

Background. Whether and how pulmonary hypertension (PH) impacts perioperative outcome in non-cardiac surgery is incompletely understood. Methods. From November 1999, all patients undergoing non-cardiac, non-local anaesthetic surgery and ever examined by echocardiography within 30 days before surgery were screened. Those having echocardiographic pulmonary artery systolic pressure .70 mm Hg were enrolled provided they were not already intubated. Case-matched peers with normal pulmonary pressures served as controls. Perioperative outcomes were compared between the two groups, and predictors of adverse perioperative outcomes were investigated by multivariate logistic regression analysis. Results. From November 1999 to August 2004, a total of 62 patients (male 38, mean age 67 yr) with PH were found. Compared with the case-matched controls, patients with PH experienced equivalently smooth operative courses, but significantly more frequent postoperative heart failure (9.7 vs 0%, P¼0.028), delayed tracheal extubation (21 vs 3%, P¼0.004), and in-hospital deaths (9.7 vs 0%, P¼0.028). Multivariate regression analysis identified emergency surgery [odds ratio (OR), 44.738; P¼0.028], coronary artery disease (CAD; OR, 9.933; P¼0.042), and systolic pulmonary artery pressure (OR, 1.101; P¼0.026) as independent predictors of postoperative mortality and surgery-specific cardiac risk level (OR, 6.791; P¼0.033) and CAD (OR 6.546, P¼0.017) as predictors of morbidity. Conclusion. PH is an important predictor of adverse cardiopulmonary outcome in noncardiac surgery as reflected by markedly increased postoperative complications, especially in patients with coexistent high-risk clinical and surgical characteristics.

Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

“…This study's most common morbidity was perioperative congestive heart failure (13%). Similarly, a recent study by Lai et al showed a major adverse event rate of 24% and a mortality of 9.7% in 62 patients with severe PH undergoing noncardiac surgery [4]. This study's most common adverse events were delayed tracheal extubation (21%) and heart failure (9.7%).…”

“…Since regional anesthesia provides optimal pain management [10] and minimizes opioid use, the likelihood of oversedation, respiratory depression, and hypoxemia is small [9]. By optimizing perioperative pain control with a patient-controlled epidural analgesia (PCEA), reductions in postoperative inflammation and sympathetic nerve activity [3] will moderate a patient's pain level and potentially minimize the severity of pulmonary hypertension [4]. However, regional anesthesia is our institution's preferred method of anesthesia (only 1 out of 230 patients in the study had general anesthesia).…”

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

“…RA was previously thought harmful in patients with PH because of the haemodynamic compromise following sympathetic blockade; however, using a low intrathecal dose minimises this potential drop in afterload, and careful incremental epidural top-ups are well tolerated. RA techniques have also been useful in patients with PH in general surgery [9,10]. RA may be an inappropriate anaesthetic technique, however, for many procedures, as well as in emergencies, when planned cessation of anticoagulation is not possible.…”

“…Patients with PH represent one of the highest-risk groups of patients undergoing both cardiac [7] and noncardiac surgery [8][9][10][11], despite advances in perioperative monitoring and treatment. Potentially fatal complications relate to the consequences of rightsided circulatory failure, which may be precipitated by reduced right ventricular contractility, excessive volume loading or causes of further right ventricular pressure overload.…”

Estimación auscultatoria de la presiónsistólica de arteria pulmonar: ¿Es factible?. Correlación con determinación ecocardiográfica

“…Es clara la importancia clínica y pronóstica que representa conocer la PSAP, tanto a corto como largo plazo, en variadas patologías como insuficiencia cardíaca aguda y crónica, tromboembolismo pulmonar, postoperatorio de cirugía cardíaca, enfermedades autoinmunes, etc [17][18][19][20][21][22][23] . Contar con un método clínico para estimar esta variable puede ser de gran utilidad en la evaluación periódica de estos pacientes, ayudando a la toma de decisiones terapéuticas en la práctica clínica diaria.…”