JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Welsby, I. J. Articles by Mythen, M. G. Search for Related Content PubMed PubMed Citation Articles by Welsby, I. J. Articles by Mythen, M. G.

---

CARDIOVASCULAR ANESTHESIA

The Association of Complication Type with Mortality and Prolonged Stay After Cardiac Surgery with Cardiopulmonary Bypass

Ian J. Welsby, FRCA^*, Elliott Bennett-Guerrero, MD^*, Darryl Atwell, MD^*, William D. White, MPH^*, Mark F. Newman, MD^*, Peter K. Smith, MD, and Michael G. Mythen, FRCA^*

Departments of *Anesthesiology and Surgery, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Ian J. Welsby, FRCA, Box 3094, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710. Address e-mail to welsb001{at}mc.duke.edu

Outcome after cardiac surgery varies depending on complication type. We therefore sought to determine the association between complication type, mortality, and length of stay in a large series of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Multivariate logistic regression was used to test for differences between complication types in mortality and prolonged length of stay (>10 days) while controlling for preoperative and intraoperative risk factors. In 2609 consecutive cardiac surgical patients requiring CPB, the mortality rate was 3.6%; 36.5% had one or more complications, and 15.7% experienced an adverse outcome (death or prolonged length of stay). Multivariate logistic regression demonstrated that complication type was significantly associated with adverse outcome (P < 0.001) independent of Parsonnet score and CPB time (c-index = 0.80). The development of noncardiac complications only (Group NC) and cardiac complications with other organ involvement (Group B) significantly increased mortality and hospital and intensive care unit length of stay (P < 0.001) when compared with cardiac complications only (Group C). The incidences of adverse outcome in Groups C, NC, and B were 15%, 43%, and 67%, respectively; the mortality rates were 3%, 7%, and 20%, respectively. All these intergroup comparisons were significantly different (adjusted P < 0.05). Complications involving organs other than the heart appear to be more deleterious than cardiac complications alone, underscoring the need for strategies to reduce noncardiac complications.

IMPLICATIONS: Complications, particularly when they involve organs other than just the heart, increase mortality and prolong the length of hospital stay after heart surgery, independent of a patient’s preoperative risk factors and the duration of cardiopulmonary bypass. Strategies aimed at preventing damage to other organs during cardiac surgery need to be improved.

This article has been cited by other articles:

				L. S. De Santo, C. Bancone, G. Santarpino, G. Romano, M. De Feo, M. Scardone, N. Galdieri, and M. Cotrufo Microbiologically documented nosocomial infections after cardiac surgery: an 18-month prospective tertiary care centre report Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 666 - 672. [Abstract] [Full Text] [PDF]

				L. G. Glance, T. M. Osler, D. B. Mukamel, and A. W. Dick Effect of complications on mortality after coronary artery bypass grafting surgery: Evidence from New York State J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 53 - 58. [Abstract] [Full Text] [PDF]

				M. Mazzoni, R. De Maria, F. Bortone, M. Parolini, R. Ceriani, C. Solinas, V. Arena, and O. Parodi Long-Term Outcome of Survivors of Prolonged Intensive Care Treatment After Cardiac Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2080 - 2087. [Abstract] [Full Text] [PDF]

				P. Gersbach, H. Tevaearai, J.-P. Revelly, P. Bize, R. Chiolero, and L. K. von Segesser Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care? Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 466 - 472. [Abstract] [Full Text] [PDF]

				E. Bennett-Guerrero, T. F. Slaughter, W. D. White, I. J. Welsby, C. S. Greenberg, H. El-Moalem, and T. L. Ortel Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1567 - 1572. [Abstract] [Full Text] [PDF]

				C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]

				M. McKendry, H. McGloin, D. Saberi, L. Caudwell, A. R Brady, and M. Singer Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery BMJ, July 31, 2004; 329(7460): 258. [Abstract] [Full Text] [PDF]

				F. Pappalardo, A. Franco, G. Landoni, P. Cardano, A. Zangrillo, and O. Alfieri Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 548 - 552. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999