The Impact of Major Postoperative Complications on Long-Term Survival After Cardiac Surgery

Seese, Laura; Sultan, Ibrahim; Gleason, Thomas G.; Navid, Forozan; Wang, Yisi; Thoma, Floyd; Kilic, Arman

doi:10.1016/j.athoracsur.2019.09.100

Cited by 44 publications

(41 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A possible explanation of this observation is the higher rate of postoperative complications encountered in hyperlactatemic patients, postoperative complications that are known to adversely affect long-term survival following cardiac surgery. 18 However, additional studies are needed to further validate this finding.…”

Section: Discussionmentioning

confidence: 94%

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

et al. 2020

View full text Add to dashboard Cite

Introduction: Lactate, a product of anaerobic metabolism, is a biomarker and indicator for tissue hypoperfusion and oxygen debt. An elevated blood lactate level has been associated with poor outcome in many clinical conditions, including cardiac surgery. Nevertheless, debate exists regarding which blood lactate concentration is most indicative of poor outcomes. We evaluate the impact of hyperlactatemia, defined as a peak arterial blood concentration ⩾2.0 mmol/L during cardiopulmonary bypass, on surgical results with a focus on long-term outcome. Methods: We reviewed 1,099 consecutive adult patients who underwent cardiac surgery on pump. The patients were divided into two groups based on the presence or not of hyperlactatemia. Pre- and intraoperative risk factors for hyperlactatemia were identified, and the postoperative outcome of patients with or without hyperlactatemia was compared. Results: Hyperlactatemia was present in 372 patients (33.8%). Factors independently associated with hyperlactatemia were urgent/emergency procedure, cardiopulmonary bypass duration and aortic cross-clamp time. Patients with hyperlactatemia had significantly higher rate of prolonged mechanical ventilation time, in-hospital stay and requirement of inotropes and intra-aortic balloon pump support (p < 0.001). Operative (30-day) mortality was higher in the group of patients with hyperlactatemia (7.8% vs. 1.1%; p < 0.001). Kaplan–Meier curve showed worse long-term survival (mean follow-up: 4.02 ± 1.58 years) in patients with hyperlactatemia. Conclusion: Hyperlactatemia during cardiopulmonary bypass has a significant association with postoperative morbidity and mortality. Correction of risk factors for hyperlactatemia, together with prompt detection and correction of this condition, may control complications and improve outcome.

show abstract

Section: Discussionmentioning

confidence: 94%

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Additionally, patients with GI bleeds, intestinal ischemia or severe C. difficile colitis may be intravascularly dry requiring extensive volume resuscitation, which may further compromise patients with reduced ejection fractions and also lead to pulmonary dysfunction. It is well appreciated that as more complications are acquired in an individual patient, the odds of mortality increase exponentially 18,19 . Furthermore, additional complications increase intensive care and hospital length of stay time, and often require additional medical, and sometimes surgical, resources for management and treatment of these complications.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The purpose of this study was to investigate the incidence, predictors, and long‐term impact of gastrointestinal (GI) complications following adult cardiac surgery. Methods Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A subanalysis of propensity score‐matched patients was also performed. Results A total of 10,285 patients were included, and the overall rate of GI complications was 2.4% (n = 246). Predictors of GI complications included dialysis dependency, intra‐aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross‐clamp times. Thirty‐day (2.6% vs. 24.8%), 1‐ (6.3% vs. 41.9%), and 3‐year (11.1% vs. 48.4%) mortality were substantially higher in patients who experienced GI complications (all p < .001). GI complication was associated with a threefold increased hazard for mortality (hazard ratio = 3.1, 95% confidence interval = 2.6–3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs. 2.5%), new dialysis dependency (31.3% vs. 1.5%), multisystem organ failure (21.5% vs .1.0%), and deep sternal wound infections (2.6% vs. 0.2%; all p < .001). These results persisted in propensity‐matched analysis. Conclusion GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appear warranted.

show abstract

“…While various studies have demonstrated the adverse effects of postoperative complications on the short‐term outcomes after cardiac surgery, their impact on long‐term outcomes has been less studied 4 . Most patients survive the hospital stay despite postoperative complications; however, the long‐term consequences on survival is not well‐known.…”

Section: Introductionmentioning

confidence: 99%

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

Pahwa¹,

Bernabei

Schaff

et al. 2021

J Card Surg

View full text Add to dashboard Cite

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.

show abstract

The Impact of Major Postoperative Complications on Long-Term Survival After Cardiac Surgery

Cited by 44 publications

References 18 publications

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes

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

Contact Info

Product

Resources

About