Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis

Abstract

Background Pleural effusions commonly occur in patients recovering from cardiac surgery; however, the impact on outcomes is not well characterized. The purpose of this study is to characterize the clinical outcomes of cardiac surgery patients with pleural effusion. Methods All patients undergoing cardiac surgery between 2006 and 2019 at a tertiary care university hospital were included in this observational, cross-sectional analysis using propensity matching. Results Of 11,037 patients that underwent cardiac surgery during the study period, 6461 (58.5%) had no pleural effusion (Group 0), 3322 (30.1%) had pleural effusion only (Group 1), and 1254 (11.4%) required at least one secondary drainage procedure after the index operation (Group 2). After propensity matching, the mortality of patients who underwent secondary drainage procedures was 6.1% higher than in Group 1 (p < 0.001). Intensive care unit (ICU) stay was longer for those with pleural effusions (18 [IQR 9–32] days in Group 2, 10 [IQR 6–17] days for Group 1, and 7 [IQR 4–11] days for Group 0, p < 0.001). Patients with pleural effusions had a higher incidence of hemodialysis (246 [20.0%] in Group 2, 137 [11.1%] in Group 1, 98 [7.98%] in Group 0), and a longer ventilation time in the ICU (57 [IQR 21.0-224.0] hours in Group 2, 25.0 [IQR 14.0–58.0] hours in Group 1, 16.0 [IQR 10.0–29.0] hours in Group 0). Conclusion Pleural effusions, especially those that require a secondary drainage procedure during recovery, are associated with significantly worse outcomes including increased mortality, longer length of stay, and higher complication rates. These insights may be of great interest to scientists, clinicians, and industry leaders alike to foster research into innovative methods for preventing and treating pleural effusions with the aim of improving outcomes for patients recovering from cardiac surgery.

Clinical implications of pleural effusion following left ventricular assist device implantation

“…Compared to patients without PE, those who developed PE after cardiac surgery and needed secondary drainage had a significantly longer hospital stay and a higher mortality rate. PE has been associated with worse outcomes after cardiac surgery [ 7 ]. In a single-center cohort study, TD after LVAD implantation was related to prolonged length of stay [ 17 ].…”

“…The lack of statistical significance may be attributed to the small sample size. Previous studies have shown that the duration of mechanical intubation is significantly longer in patients with PE after cardiac surgery, suggesting that TD might help reduce the duration of mechanical intubation [ 7 ]. Patients experienced a decrease in symptoms and increased walking distance 1 month postoperatively when TD was performed [ 19 ].…”

Diagnosis and Treatment of Postoperative Dyspnea: Literature Review

“…Post-surgical pleural effusion is the accumulation of fluid in the pleura after surgery. Pleural effusion can occur in 41 to 89% of patients undergoing procedures such as CABG especially in the first 7 days after surgery [8]. Accumulation of excess fluid can occur if excessive production, decreased absorption, or both exceed normal homeostatic mechanisms.…”

“…In the postsurgical period, there may be disturbances in hydrostatic pressure and homeostasis resulting in pleural effusion. The most common type of pleural effusion is transudate [7,8,9].…”

Residual Neuromuscular Block Remains a Safety Concern for Perioperative Healthcare Professionals: A Comprehensive Review

“…The deleterious effects of these underlying conditions are compounded by the sequelae of cardiac and thoracic surgery. Postoperative pulmonary edema, pleural effusions, and impaired respiratory mechanics including reduced functional residual capacity (FRC), decreased lung compliance and impaired cough may all be exacerbated by residual neuromuscular block [60,61].…”