Predictors of operative mortality among cardiac surgery patients with prolonged ventilation
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 predic...
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| Veröffentlicht in: | Journal of cardiac surgery 2019-09, Vol.34 (9), p.759-766 |
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| container_title | Journal of cardiac surgery |
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| creator | Suarez‐Pierre, Alejandro Fraser, Charles D Zhou, Xun Crawford, Todd C Lui, Cecillia Metkus, Thomas S Whitman, Glenn J Higgins, Robert SD Lawton, Jennifer S |
| description | 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. |
| doi_str_mv | 10.1111/jocs.14118 |
| format | Article |
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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.</description><identifier>ISSN: 0886-0440</identifier><identifier>EISSN: 1540-8191</identifier><identifier>DOI: 10.1111/jocs.14118</identifier><identifier>PMID: 31269299</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Cardiac Surgical Procedures - mortality ; coronary artery disease ; Female ; Follow-Up Studies ; Humans ; Length of Stay - trends ; Male ; Middle Aged ; Morbidity - trends ; Postoperative Care - methods ; Postoperative Complications - epidemiology ; Respiration, Artificial - adverse effects ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; Survival Rate - trends ; Time Factors ; United States - epidemiology ; valve repair/replacement</subject><ispartof>Journal of cardiac surgery, 2019-09, Vol.34 (9), p.759-766</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3658-1fc5b8cf337d37a23ebb2e76c8cf23c9fc6ea2f591e88da1aee770533d5fd9b13</citedby><cites>FETCH-LOGICAL-c3658-1fc5b8cf337d37a23ebb2e76c8cf23c9fc6ea2f591e88da1aee770533d5fd9b13</cites><orcidid>0000-0001-7515-3149 ; 0000-0001-5179-5032 ; 0000-0002-6969-4165 ; 0000-0003-4761-3296 ; 0000-0003-1821-6240</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjocs.14118$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjocs.14118$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31269299$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suarez‐Pierre, Alejandro</creatorcontrib><creatorcontrib>Fraser, Charles D</creatorcontrib><creatorcontrib>Zhou, Xun</creatorcontrib><creatorcontrib>Crawford, Todd C</creatorcontrib><creatorcontrib>Lui, Cecillia</creatorcontrib><creatorcontrib>Metkus, Thomas S</creatorcontrib><creatorcontrib>Whitman, Glenn J</creatorcontrib><creatorcontrib>Higgins, Robert SD</creatorcontrib><creatorcontrib>Lawton, Jennifer S</creatorcontrib><title>Predictors of operative mortality among cardiac surgery patients with prolonged ventilation</title><title>Journal of cardiac surgery</title><addtitle>J Card Surg</addtitle><description>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.</description><subject>Aged</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>coronary artery disease</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Length of Stay - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity - trends</subject><subject>Postoperative Care - methods</subject><subject>Postoperative Complications - epidemiology</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><subject>valve repair/replacement</subject><issn>0886-0440</issn><issn>1540-8191</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtKw0AUhgdRbK1ufACZpQipc8l1KcUrQgV15SJMJmfqlCQTZ5KWvL1TU116Ngf-8_Fz-BA6p2RO_VyvjXRzGlKaHqApjUISpDSjh2hK0jQOSBiSCTpxbk0IYyEnx2jCKYszlmVT9PFiodSyM9Zho7BpwYpObwDXxnai0t2ARW2aFZbCllpI7Hq7Ajvg1mPQdA5vdfeJW2sqT0GJNz7UlT-a5hQdKVE5ONvvGXq_u31bPATPy_vHxc1zIHkcpQFVMipSqThPSp4IxqEoGCSx9BnjMlMyBsFUlFFI01JQAZAkJOK8jFSZFZTP0OXY67_46sF1ea2dhKoSDZje5YxFjMVxFDKPXo2otMY5Cypvra6FHXJK8p3MfCcz_5Hp4Yt9b1_UUP6hv_Y8QEdgqysY_qnKn5aL17H0G5ptghw</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Suarez‐Pierre, Alejandro</creator><creator>Fraser, Charles D</creator><creator>Zhou, Xun</creator><creator>Crawford, Todd C</creator><creator>Lui, Cecillia</creator><creator>Metkus, Thomas S</creator><creator>Whitman, Glenn J</creator><creator>Higgins, Robert SD</creator><creator>Lawton, Jennifer S</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7515-3149</orcidid><orcidid>https://orcid.org/0000-0001-5179-5032</orcidid><orcidid>https://orcid.org/0000-0002-6969-4165</orcidid><orcidid>https://orcid.org/0000-0003-4761-3296</orcidid><orcidid>https://orcid.org/0000-0003-1821-6240</orcidid></search><sort><creationdate>201909</creationdate><title>Predictors of operative mortality among cardiac surgery patients with prolonged ventilation</title><author>Suarez‐Pierre, Alejandro ; Fraser, Charles D ; Zhou, Xun ; Crawford, Todd C ; Lui, Cecillia ; Metkus, Thomas S ; Whitman, Glenn J ; Higgins, Robert SD ; Lawton, Jennifer S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3658-1fc5b8cf337d37a23ebb2e76c8cf23c9fc6ea2f591e88da1aee770533d5fd9b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>coronary artery disease</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Length of Stay - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity - trends</topic><topic>Postoperative Care - methods</topic><topic>Postoperative Complications - epidemiology</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><topic>United States - epidemiology</topic><topic>valve repair/replacement</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suarez‐Pierre, Alejandro</creatorcontrib><creatorcontrib>Fraser, Charles D</creatorcontrib><creatorcontrib>Zhou, Xun</creatorcontrib><creatorcontrib>Crawford, Todd C</creatorcontrib><creatorcontrib>Lui, Cecillia</creatorcontrib><creatorcontrib>Metkus, Thomas S</creatorcontrib><creatorcontrib>Whitman, Glenn J</creatorcontrib><creatorcontrib>Higgins, Robert SD</creatorcontrib><creatorcontrib>Lawton, Jennifer S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suarez‐Pierre, Alejandro</au><au>Fraser, Charles D</au><au>Zhou, Xun</au><au>Crawford, Todd C</au><au>Lui, Cecillia</au><au>Metkus, Thomas S</au><au>Whitman, Glenn J</au><au>Higgins, Robert SD</au><au>Lawton, Jennifer S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of operative mortality among cardiac surgery patients with prolonged ventilation</atitle><jtitle>Journal of cardiac surgery</jtitle><addtitle>J Card Surg</addtitle><date>2019-09</date><risdate>2019</risdate><volume>34</volume><issue>9</issue><spage>759</spage><epage>766</epage><pages>759-766</pages><issn>0886-0440</issn><eissn>1540-8191</eissn><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.</abstract><cop>United States</cop><pmid>31269299</pmid><doi>10.1111/jocs.14118</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7515-3149</orcidid><orcidid>https://orcid.org/0000-0001-5179-5032</orcidid><orcidid>https://orcid.org/0000-0002-6969-4165</orcidid><orcidid>https://orcid.org/0000-0003-4761-3296</orcidid><orcidid>https://orcid.org/0000-0003-1821-6240</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of cardiac surgery, 2019-09, Vol.34 (9), p.759-766 |
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| subjects | Aged Cardiac Surgical Procedures - mortality coronary artery disease Female Follow-Up Studies Humans Length of Stay - trends Male Middle Aged Morbidity - trends Postoperative Care - methods Postoperative Complications - epidemiology Respiration, Artificial - adverse effects Retrospective Studies Risk Assessment - methods Risk Factors Survival Rate - trends Time Factors United States - epidemiology valve repair/replacement |
| title | Predictors of operative mortality among cardiac surgery patients with prolonged ventilation |
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