Impact of postoperative complications after cardiac surgery on long‐term survival

Abstract

Purpose The impact of postoperative complications on long‐term survival is not well characterized. We sought to study the prevalence of postoperative complications after cardiac surgery and their impact on long‐term survival. Methods Operative survivors (n = 26,221) who underwent coronary artery bypass grafting (CABG) (n = 13,054, 49.8%), valve surgery (n = 8667, 33.1%) or combined CABG and valve surgery (n = 4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for postoperative complications and long‐term survival. Propensity‐match analysis was performed between patients who did and did not have a postoperative complication. The associations between postoperative complications and survival were assessed using a Cox‐proportional model. Results Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 postoperative complications were analyzed. Postoperative blood product use was the commonest (n = 12,397, 47.3%), followed by atrial fibrillation (n = 8399, 32.0%), prolonged ventilation (n = 2336, 8.9%), renal failure (n = 870, 3.3%), reoperation for bleeding (n = 859, 3.3%) and pacemaker/ICD insertion (n = 795, 3.0%). Stroke (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.36–1.77), renal failure (HR: 1.45; 95% CI: 1.33–1.58) and pneumonia (HR: 1.23; 95% CI: 1.11–1.36) had the strongest impact on long‐term survival. Long‐term survival decreased as the number of postoperative complications increased. Conclusions Postoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long‐term survival.

Risk stratification score to determine long-term outcomes based on post-operative complications following cardiac surgery -- need of the hour?

“…2 Pahwa and colleagues further reported the impact of seventeen common post-operative complications and analyzed their impact on long-term survival. 3 The effect of multiple complications and various combinations of complications were also investigated and, understandably, the greater the number of complications, the worse was the survival. 2,3 The formulation of a risk stratification score based on post-operative complications following common cardiac surgical procedures may be used to estimate the likelihood of long-term survival for individual complications, as well as various permutations and combinations of complications.…”

“…3 The effect of multiple complications and various combinations of complications were also investigated and, understandably, the greater the number of complications, the worse was the survival. 2,3 The formulation of a risk stratification score based on post-operative complications following common cardiac surgical procedures may be used to estimate the likelihood of long-term survival for individual complications, as well as various permutations and combinations of complications. This may have profound implications in devising strategies to prevent the most devastating combination of complications.…”

Risk stratification score to determine long‐term outcomes based on postoperative complications following cardiac surgery—Need of the hour?

“…Recently published data by Seese et al 2 reported the impact of the STS-defined major morbidities (prolonged ventilation, deep sternal wound infection, renal failure, reoperation, and stroke) on long-term outcomes. Pahwa et al 3 further reported the impact of 17 common postoperative complications and analyzed their impact on long-term survival. 3 The effect of multiple complications and various combinations of complications were also investigated and, understandably, the greater the number of complications, the worse was the survival.…”

“…3 The effect of multiple complications and various combinations of complications were also investigated and, understandably, the greater the number of complications, the worse was the survival. 2,3 The formulation of a risk stratification score based on postoperative complications following common cardiac surgical procedures may be used to estimate the likelihood of long-term survival for individual complications, as well as various permutations and combinations of complications. This may have profound implications in devising strategies to prevent the most devastating combination of complications.…”

“…Pahwa et al 3 further reported the impact of 17 common postoperative complications and analyzed their impact on long-term survival. 3 The effect of multiple complications and various combinations of complications were also investigated and, understandably, the greater the number of complications, the worse was the survival. 2,3 The formulation of a risk stratification score based on postoperative complications following common cardiac surgical procedures may be used to estimate the likelihood of long-term survival for individual complications, as well as various permutations and combinations of complications.…”