Sustained Pulmonary Hypertension in Surgical Patients

Draughn, D; Morris, Don M.

doi:10.1097/00132586-199402000-00003

Cited by 2 publications

(2 citation statements)

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“…Pulmonary hypertension (PH), defined as a mean pulmonary artery pressure ≥25 mmHg at rest, 1 can be identified by echocardiography in ~0.7% of patients referred for non-cardiac surgery. 2 Patients with PH are at an increased risk of adverse events in the perioperative period, [3][4][5] with cardiovascular risks that may vary based on the severity of the hemodynamic abnormality, underlying mechanism of disease, the presence of cardiovascular risk factors and cormorbidities, and the type of non-cardiac surgery to be performed. Unfortunately, few studies have identified large cohorts of patients with PH undergoing non-cardiac surgery in the contemporary era.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery

Smilowitz

Armanious

Bangalore

et al. 2019

The American Journal of Cardiology

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Pulmonary hypertension (PH), defined by a mean pulmonary artery pressure of >25mm Hg at rest, is strongly associated with morbidity and mortality in the perioperative period. The prevalence and outcomes of PH among patients referred for major non-cardiac surgery in the United States are unknown. Patients ≥18 years of age hospitalized for non-cardiac surgery were identified from Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample (NIS) data from 2004 to 2014. Pulmonary hypertension was defined by ICD-9 diagnosis codes. The primary outcome was perioperative major adverse cardiovascular events (MACCE), defined as in-hospital death, myocardial infarction (MI), or ischemic stroke. Among 17,853,194 hospitalizations for major non-cardiac surgery, 143,846 (0.81%) had PH. MACCE occurred in 8.3% of hospitalizations with any diagnosis of PH in comparison to 2.0% of those without PH (p<0.001), driven by an increased frequency of death (4.4% vs. 1.1%, p<0.001) and non-fatal MI (3.2% vs. 0.6%, p<0.001). After adjusting for demographics, clinical covariates, and surgery type, PH remained independently associated with MACCE (aOR 1.43, 95% CI 1.40-1.46). In conclusion, PH is associated with perioperative major adverse cardiovascular events. Careful patient selection, recognition of perioperative risks, and appropriate intraoperative hemodynamic monitoring may improve perioperative cardiovascular outcomes.

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Section: Introductionmentioning

confidence: 99%

Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery

Smilowitz

Armanious

Bangalore

et al. 2019

The American Journal of Cardiology

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“…A study in Chicago of 1118 subjects who were undergoing coronary angiography for suspected heart disease showed that the finding of pulmonary hypertension, independent of left ventricular dysfunction, was the single most important predictor of the likelihood of death over the subsequent two years 7. Pulmonary hypertension also has important prognostic implications in critically ill surgical patients8 and in those with chronic obstructive pulmonary disease (COPD) 9…”

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confidence: 99%