Years of Life Lost After Complications of Coronary Artery Bypass Operations

Freundlich, Robert E.; Maile, Michael D.; Hajjar, Mark M.; Jewell, Elizabeth S.; Schwann, Thomas A.; Habib, Robert H.; Engoren, Milo

doi:10.1016/j.athoracsur.2016.09.048

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…1,3,5,6,8,9,11 We found that mechanical ventilation on days 7, 14, 21, and 28 was strongly associated Intensive Care Unit with operative mortality, similar to noncardiac surgery patients and cardiac surgery patients. 6,23,24 While we found several processes of care, such as catecholamine use and transfusions to be associated with mortality, which is similar to other studies, notably, we did not find an association between renal replacement therapy and mortality. 1,25 While there is an association between renal replacement therapy and mortality in ICU patients, its status in cardiac surgery patients with prolonged ICU stays is less clear.…”

Section: Discussionsupporting

confidence: 89%

Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients

Curran¹

2022

Federal Practitioner

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Background: Prolonged postoperative intensive care unit (ICU) stays are common after cardiac surgery and are associated with poor outcomes. There are few studies evaluating how risk factors associated with mortality may change during prolonged ICU stays or how mortality may vary with length of stay. We evaluated operative and long-term mortality in postcardiac surgery patients after prolonged ICU stays at 7, 14, 21, and 28 days and factors associated with mortality. Methods: We included University of Michigan Medical Center cardiac surgery patients with ≥ 7 postoperative days in the ICU. We determined factors associated with hospital mortality at 7, 14, 21, and 28 days of ICU stay using logistic regression, and among hospital survivors, we determined the factors associated with long-term mortality using Cox regression.Results: Of 8309 ICU admissions from cardiac surgery, 1174 (14%) had ICU stays > 7 days. Operative mortality was 11%, 18%, 22%, and 35% for the 7-, 14-, 21-, and 28-day groups, respectively. Mechanical ventilation on the day of assessment was associated with increased odds ratios of operative mortality in all models. Of the 1049 (89%) hospital survivors, 420 (40%) died by late follow-up. Median (IQR) Cox model survival was 10.7 (0.7) years. Longer ICU stays, postoperative pneumonia, and elevated discharge blood urea nitrogen were associated with increased hazard of dying; whereas higher discharge platelet count and cardiac transplant were protective. Conclusions: Both operative and late mortality increased as the duration of a ICU stay increased after cardiac surgery.

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Section: Discussionsupporting

confidence: 89%

Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients

Curran¹

2022

Federal Practitioner

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“…Despite the steady improvements in survival and operative safety, postoperative complications still cause significant morbidity and suffer among operated patients [ 5 , 14 ]. The impact of postoperative complications is mainly evaluated in survival [ 14 , 15 ] and economical [ 16 ] perspectives. However, the effect of postoperative complications on patients’ quality of life in long term is hitherto unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of postoperative complications after CABG surgery ranges between 30 and 40% depending on the number of different complication included in the studies [ 14 , 15 , 20 ]. These findings are in line with the incidence of postoperative complication, 40%, represented in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

The effect of postoperative complications on health-related quality of life and survival 12 years after coronary artery bypass grafting – a prospective cohort study

Hokkanen

Laurikka

Järvinen

2021

J Cardiothorac Surg

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Background Despite the steady improvements in survival and operative safety, postoperative complications still remain a significant cause of morbidity and mortality after coronary artery bypass grafting (CABG). However, less is known on the impact of postoperative complications on health-related quality of life (QoL). The main objective of our study was to investigate the impact of postoperative complications on long-term QoL and survival after CABG surgery. Methods Data of 508 patients, who underwent isolated CABG was prospectively collected. The RAND-36 Health Survey (RAND-36) was used to evaluate patients’ QoL status preoperatively, 1 year and 12 years after the surgery. Predefined postoperative complications were reported during primary and secondary hospital stay. QoL and survival analysis were performed primarily on three patient groups: patients with and without complications and patients with major adverse cardiac and cerebrovascular events (MACCE). Results In total 205(40%) of 508 patients had at least one postoperative complication and 73 (14%) experienced MACCE. Patients’ thirty-day, 1-year and 10-year survival rates were, 99, 98, 84% without complications, 97, 95, 72% with complications, and 90, 89, 64% with MACCE, respectively (log-rank p < 0.001). Patients without complications showed significant(p < 0.05) improvements in seven and patients with complications in five out of eight RAND-36 QoL dimensions. All patient groups showed significant improvements in RAND-36 summary scores compared with preoperative values. Patients with complications and especially with MACCE had more profound decline in their RAND-36 summary scores while patients without complications maintained their health status best. Conclusions Despite the constant deterioration, both patients with and without complications showed improvements even 12 years after CABG compared with preoperative state. Postoperative complications and especially MACCE were associated with impaired long-term QoL.

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“… 1 Following failed extubation, these patients are more likely to experience prolonged intensive care unit stay, hospitalisation, excess morbidity and subsequent mortality. 2–6 …”

Section: Introductionmentioning

confidence: 99%

“…1 Following failed extubation, these patients are more likely to experience prolonged intensive care unit stay, hospitalisation, excess morbidity and subsequent mortality. [2][3][4][5][6] Treatment with heated, humidified, highflow nasal cannula (HFNC) oxygen has been proposed a therapy for hypoxic respiratory failure in numerous clinical settings. 7 HFNC can deliver up to 100% oxygen at a maximum flow of 60 L/min via nasal cannula, offering important physiological advantages, including improved dead space ventilation, mucociliary clearance and offering some positive end expiratory pressure, compared with standard oxygen therapy.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a randomised controlled trial: reducing reintubation among high-risk cardiac surgery patients with high-flow nasal cannula (I-CAN)

et al. 2022

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IntroductionHeated, humidified, high-flow nasal cannula oxygen therapy has been used as a therapy for hypoxic respiratory failure in numerous clinical settings. To date, limited data exist to guide appropriate use following cardiac surgery, particularly among patients at risk for experiencing reintubation. We hypothesised that postextubation treatment with high-flow nasal cannula would decrease the all-cause reintubation rate within the 48 hours following initial extubation, compared with usual care.Methods and analysisAdult patients undergoing cardiac surgery (open surgery on the heart or thoracic aorta) will be automatically enrolled, randomised and allocated to one of two treatment arms in a pragmatic randomised controlled trial at the time of initial extubation. The two treatment arms are administration of heated, humidified, high-flow nasal cannula oxygen postextubation and usual care (treatment at the discretion of the treating provider). The primary outcome will be all-cause reintubation within 48 hours of initial extubation. Secondary outcomes include all-cause 30-day mortality, hospital length of stay, intensive care unit length of stay and ventilator-free days. Interaction analyses will be conducted to assess the differential impact of the intervention within strata of predicted risk of reintubation, calculated according to our previously published and validated prognostic model.Ethics and disseminationVanderbilt University Medical Center IRB approval, 15 March 2021 with waiver of written informed consent. Plan for publication of study protocol prior to study completion, as well as publication of results.Trial registration numberclinicaltrials.gov,NCT04782817submitted 25 February 2021.Date of protocol29 August 2022. Version 2.0.

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Years of Life Lost After Complications of Coronary Artery Bypass Operations

Cited by 9 publications

References 28 publications

Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients

Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients

The effect of postoperative complications on health-related quality of life and survival 12 years after coronary artery bypass grafting – a prospective cohort study

Protocol for a randomised controlled trial: reducing reintubation among high-risk cardiac surgery patients with high-flow nasal cannula (I-CAN)

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