Long-Lasting Functional Disabilities in Patients Who Recover From Coma After Cardiac Operations

Background Uncertainty regarding the long-term functional outcome of patients who awaken from coma after cardiac operations is difficult for families and physicians and may delay rehabilitation. We studied the long-term functional status of these patients to determine if duration of coma predicted o...

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Veröffentlicht in:The Annals of thoracic surgery 2013-03, Vol.95 (3), p.884-890
Hauptverfasser: Rodriguez, Rosendo A., MD, PhD, Nair, Shona, MD, Bussière, Miguel, MD, PhD, Nathan, Howard J., MD
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Sprache:eng
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Zusammenfassung:Background Uncertainty regarding the long-term functional outcome of patients who awaken from coma after cardiac operations is difficult for families and physicians and may delay rehabilitation. We studied the long-term functional status of these patients to determine if duration of coma predicted outcome. Methods We followed 71 patients who underwent cardiac operations; recovered their ability to respond to verbal commands after coma associated with postoperative stroke, encephalopathy, and/or seizures; and were discharged from the hospital. The Glasgow Outcome Scale Extended (GOSE) was used to assess functional disability 2 to 4 years after discharge. Outcomes were classified as favorable (GOSE scores 7 and 8) and unfavorable (GOSE scores 1–6). Results Of 71 patients identified, 39 were interviewed, 15 died, 1 refused to be interviewed, and 16 were lost to follow-up. Of the 54 patients with completed GOSE evaluations, only 15 (28%) had favorable outcomes. Among patients with unfavorable outcomes, 15 (28%) died, 14 (26%) survived with moderate disabilities, and 10 (18%) had severe disabilities. Factors associated with unfavorable outcomes were increases in duration of coma ( p = 0.007), time in intensive care ( p = 0.006), length of hospitalization ( p = 0.004), and postoperative serum creatine kinase levels ( p = 0.006). Only duration of coma was an independent predictor of unfavorable outcome (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.008–1.537; p = 0.042). Patients with durations of coma greater than 4 days were more likely to have unfavorable outcomes (OR, 5.1; 95% CI, 1.3–21.3; p = 0.02). Conclusions Two thirds of comatose patients who survived to discharge after cardiac operations had unfavorable long-term functional outcomes. A longer duration of unconsciousness is a predictor of unfavorable outcome.
ISSN:0003-4975
1552-6259
DOI:10.1016/j.athoracsur.2012.09.032