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Article ; Online: Associations Between Socioeconomic Status, Patient Risk, and Short-Term Intensive Care Outcomes.

Mullany, Daniel V / Pilcher, David V / Dobson, Annette J

2021 Volume 49, Issue 9, Page(s) e849–e859

Abstract: Objectives: To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia.: Design: Secondary ... ...

Abstract	Objectives: To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia. Design: Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation linked to the publicly available area-level Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Bureau of Statistics. Setting: Adult ICUs from 35 hospitals in Queensland, Australia, from 2006 to 2015. Patients: A total of 218,462 patient admissions. Interventions: None. Measurements and main results: The outcome measure was inhospital mortality. The main study variable was decile of Index of Relative Socioeconomic Advantage and Disadvantage. The overall crude inhospital mortality was 7.8%; 9% in the most disadvantaged decile and 6.9% in the most advantaged decile (p < 0.001). Increasing socioeconomic disadvantage was associated with increasing severity of illness as measured by Acute Physiology and Chronic Health Evaluation III score, admission with a diagnosis of sepsis or trauma, cardiac, respiratory, renal, and hepatic comorbidities, and remote location. Increasing socioeconomic advantage was associated with elective surgical admission, hematological and oncology comorbidities, and admission to a private hospital (all p < 0.001). After excluding patients admitted after elective surgery, in the remaining 106,843 patients, the inhospital mortality was 13.6%, 13.3% in the most disadvantaged, and 14.1% in the most advantaged. There was no trend in mortality across deciles of socioeconomic status after excluding elective surgery patients. In the logistic regression model adjusting for severity of illness and diagnosis, there was no statistically significant difference in the odds ratio of inhospital mortality for the most disadvantaged decile compared with other deciles. This suggests variables used for risk adjustment may lie on the causal pathway between socioeconomic status and outcome in ICU patients. Conclusions: Socioeconomic status as defined as Index of Relative Socioeconomic Advantage and Disadvantage of the area in which a patient lives was associated with ICU admission diagnosis, comorbidities, severity of illness, and crude inhospital mortality in this study. Socioeconomic status was not associated with inhospital mortality after excluding elective surgical patients or when adjusted for severity of illness and admission diagnosis. Commonly used measures for risk adjustment in intensive care improve understanding of the pathway between socioeconomic status and outcomes.
MeSH term(s)	APACHE ; Adult ; Aged ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Outcome Assessment, Health Care/methods ; Outcome Assessment, Health Care/statistics & numerical data ; Queensland ; Retrospective Studies ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Severity of Illness Index ; Social Class
Language	English
Publishing date	2021-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005051
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Article ; Online: Effect of preoperative renal function on long-term survival after cardiac surgery.

Dhanani, Jayesh / Mullany, Daniel V / Fraser, John F

The Journal of thoracic and cardiovascular surgery

2013 Volume 146, Issue 1, Page(s) 90–95

Abstract: Objectives: The study objective was to investigate the effect of renal failure on intermediate-term survival in cardiac surgery patients.: Methods: All patients aged 18 years or older undergoing coronary artery bypass grafting, valvular surgery, ... ...

Abstract	Objectives: The study objective was to investigate the effect of renal failure on intermediate-term survival in cardiac surgery patients. Methods: All patients aged 18 years or older undergoing coronary artery bypass grafting, valvular surgery, thoracic aortic surgery, or a combination of these from January 1, 2002 to December 1, 2005 were included. Data were obtained from the cardiac surgery and intensive care databases. Using a matching algorithm, the date of death was obtained from the National Death Index. The simplified Medical Diet for Renal Disease formula was used to calculate the estimated glomerular filtration rate, and the patients were stratified accordingly. An estimation of the effect of the preoperative renal function on the interval to death was determined using Cox regression analysis with and without cubic splines and polynomial regression. The long-term survival was described using the Kaplan-Meier product limit method. Results: A total of 5297 patients were included in the present study. The vital status of all patients was obtained at a mean of 2.9 years (range, 1-5) postoperatively. The actuarial 1-year survival rate was 96% ± 1%, and the 3-year survival rate was 92% ± 1%. The greatest early mortality occurred in the severe renal dysfunction group; however, the dialysis-dependent renal failure group showed increased mortality over time compared with the other groups. The lowest risk of death (longest interval to death) occurred with an estimated glomerular filtration rate of approximately 90 mL/min/1.73 m(2). Conclusions: The results of our study have shown that preoperative renal dysfunction is an independent predictor of long-term mortality in cardiac surgery patients.
MeSH term(s)	Aged ; Cardiac Surgical Procedures/mortality ; Female ; Heart Diseases/complications ; Heart Diseases/surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Renal Insufficiency, Chronic/complications ; Survival Rate ; Time Factors
Language	English
Publishing date	2013-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2012.06.037
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Article ; Online: Measuring the quality of perioperative care in cardiac surgery.

Coulson, Tim G / Mullany, Daniel V / Reid, Christopher M / Bailey, Michael / Pilcher, David

European heart journal. Quality of care & clinical outcomes

2017 Volume 3, Issue 1, Page(s) 11–19

Abstract: Quality of care is of increasing importance in health and surgical care. In order to maintain and improve quality, we must be able to measure it and identify variation. In this narrative review, we aim to identify measures used in the assessment of ... ...

Abstract	Quality of care is of increasing importance in health and surgical care. In order to maintain and improve quality, we must be able to measure it and identify variation. In this narrative review, we aim to identify measures used in the assessment of quality of care in cardiac surgery and to evaluate their utility. The electronic databases Pubmed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and CINAHL were searched for original published studies using the terms 'cardiac surgery' and 'quality or outcome or process or structure' as either keywords in the title or text or MeSH terms. Secondary searches and identification of references from original articles were carried out. We found a total of 54 original articles evaluating measurements of quality. While structure, process, and outcome indicators remain the mainstay of quality measurement, new and innovative methods of risk assessment have improved reliability and discrimination. Continuous assessment provides a promising method of both maintaining and improving quality of care. Future studies should focus on long-term and patient-centred outcomes, such as quality-of-life measures.
MeSH term(s)	Cardiac Surgical Procedures ; Humans ; Outcome Assessment (Health Care)/standards ; Perioperative Care/standards ; Quality Improvement ; Reproducibility of Results
Language	English
Publishing date	2017-09-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2823451-0
ISSN	2058-1742 ; 2058-5225
ISSN (online)	2058-1742
ISSN	2058-5225
DOI	10.1093/ehjqcco/qcw027
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Article ; Online: Routine angiography in survivors of out of hospital cardiac arrest with return of spontaneous circulation: a single site registry.

Wijesekera, Vishva A / Mullany, Daniel V / Tjahjadi, Catherina A / Walters, Darren L

BMC cardiovascular disorders

2014 Volume 14, Page(s) 30

Abstract: Background: Coronary revascularization in resuscitated out of hospital cardiac arrest (OOHCA) patients has been associated with improved survival.: Methods: This was a retrospective review of patients with OOHCA between 01/07/2007 and 31/03/2009 ... ...

Abstract	Background: Coronary revascularization in resuscitated out of hospital cardiac arrest (OOHCA) patients has been associated with improved survival. Methods: This was a retrospective review of patients with OOHCA between 01/07/2007 and 31/03/2009 surviving to hospital admission. Cardiac risk factors, demographics, treatment times, electrocardiogram (ECG), angiographic findings and in-hospital outcomes were recorded. Results: Of the 78 patients, 63 underwent coronary angiography. Traditional cardiac risk factors were common in this group. Chest pain occurred in 33.3% pre-arrest, 59.0% were initially treated at a peripheral hospital, 83.3% had documented ventricular tachycardia or ventricular fibrillation, 55.1% had specific ECG changes, 65.4% had acute myocardial infarction (AMI) as the cause of OOHCA and the majority had multi-vessel disease. ST elevation strongly predicted AMI. The in-hospital survival was 67.9% with neurological deficit in 13.2% of survivors. The group of patients who had an angiogram were more likely to have AMI as a cause of cardiac arrest (71.4% vs 40.0%, p = 0.01) and more likely to have survived to discharge (74.6% vs 40.0%, p < 0.01). Poor outcome was associated with older age, cardiogenic shock, longer transfer times, diabetes, renal impairment and a long duration to return of spontaneous circulation. Conclusions: Acute myocardial infarction was the commonest cause of OOHCA and a high rate of survival to discharge was seen with a strategy of routine angiography and revascularization.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arrhythmias, Cardiac/complications ; Arrhythmias, Cardiac/therapy ; Blood Circulation ; Coronary Angiography ; Coronary Artery Disease/complications ; Coronary Artery Disease/therapy ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/complications ; Myocardial Infarction/therapy ; Myocardial Revascularization ; Out-of-Hospital Cardiac Arrest/diagnostic imaging ; Out-of-Hospital Cardiac Arrest/etiology ; Out-of-Hospital Cardiac Arrest/physiopathology ; Out-of-Hospital Cardiac Arrest/therapy ; Patient Admission ; Patient Discharge ; Predictive Value of Tests ; Queensland ; Recovery of Function ; Registries ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survivors ; Time Factors ; Transportation of Patients ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2014-03-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/1471-2261-14-30
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Article ; Online: Impact of blood product transfusion on short and long-term survival after cardiac surgery: more evidence.

Bhaskar, Balu / Dulhunty, Joel / Mullany, Daniel V / Fraser, John F

The Annals of thoracic surgery

2012 Volume 94, Issue 2, Page(s) 460–467

Abstract: Background: Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are ... ...

Abstract	Background: Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery. Methods: Data from 5,342 patients who underwent a cardiac surgical procedure from January 2002 to December 2005 at our institution were reviewed. The effect of transfusion of packed red blood cells (PRBC) and other blood products was tested in a 2-level approach of transfusion (any) versus no transfusion, and also a 4-level approach of transfusion (PRBC, other blood products, and both blood and blood products) versus no transfusion. Long-term survival data of these patients were obtained. Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions were used to compare the groups. Results: A total of 3,013 of the 5,342 study patients (56.4%) received transfusion during or within 72 hours of their cardiac surgery. Median time to death was significantly lower for patients who received transfusions; 1.15 years for PRC and 0.83 years for any transfusion, compared with 4.68 years in the non-transfused group. The overall 30-day mortality was 1.7%, but in patients who received transfusions (3.6%) was significantly higher than the non-transfused group (0.3%, p<0.001). The 1-year mortality (overall 3.9%) in the transfused group (7.3%, p<0.001) was also significantly higher than that in the non-transfused group (1.3%). The 5-year mortality rate in the transfused group was more than double that in the non-transfused group (16% vs 7%). After correction for comorbidities and other factors, transfusion was still associated with a 66% increase in mortality. Conclusions: This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.
MeSH term(s)	Aged ; Cardiac Surgical Procedures/mortality ; Erythrocyte Transfusion/adverse effects ; Erythrocyte Transfusion/mortality ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Time Factors
Language	English
Publishing date	2012-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2012.04.005
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Article ; Online: Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review.

Shekar, Kiran / Mullany, Daniel V / Thomson, Bruce / Ziegenfuss, Marc / Platts, David G / Fraser, John F

Critical care (London, England)

2014 Volume 18, Issue 3, Page(s) 219

Abstract: Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical ... ...

Abstract	Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical and cardiology procedures, implantation of long-term mechanical cardiac assist devices, heart and lung transplantation and cardiopulmonary resuscitation. Available ECLS therapies provide a range of options to the multidisciplinary teams who are involved in the time-critical care of these complex patients. While venovenous extracorporeal membrane oxygenation (ECMO) can provide complete respiratory support, extracorporeal carbon dioxide removal facilitates protective lung ventilation and provides only partial respiratory support. Mechanical circulatory support with venoarterial (VA) ECMO employed in a traditional central/peripheral fashion or in a temporary ventricular assist device configuration may stabilise patients with decompensated cardiac failure who have evidence of end-organ dysfunction, allowing time for recovery, decision-making, and bridging to implantation of a long-term mechanical circulatory support device and occasionally heart transplantation. In highly selected patients with combined severe cardiac and respiratory failure, advanced ECLS can be provided with central VA ECMO, peripheral VA ECMO with timely transition to venovenous ECMO or VA-venous ECMO upon myocardial recovery to avoid upper body hypoxia or by addition of an oxygenator to the temporary ventricular assist device circuit. This article summarises the available ECLS options and provides insights into the principles and practice of these techniques. One should emphasise that, as is common with many emerging therapies, their optimal use is currently not backed by quality evidence. This deficiency needs to be addressed to ensure that the full potential of ECLS can be achieved.
MeSH term(s)	Acute Disease ; Critical Care/methods ; Disease Management ; Extracorporeal Membrane Oxygenation/methods ; Heart Failure/therapy ; Humans ; Respiratory Insufficiency/therapy
Language	English
Publishing date	2014-05-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/cc13865
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Article ; Online: To ventilate, oscillate, or cannulate?

Shekar, Kiran / Davies, Andrew R / Mullany, Daniel V / Tiruvoipati, Ravindranath / Fraser, John F

Journal of critical care

2013 Volume 28, Issue 5, Page(s) 655–662

Abstract: Ventilatory management of acute respiratory distress syndrome has evolved significantly in the last few decades. The aims have shifted from optimal gas transfer without concern for iatrogenic risks to adequate gas transfer while minimizing lung injury. ... ...

Abstract	Ventilatory management of acute respiratory distress syndrome has evolved significantly in the last few decades. The aims have shifted from optimal gas transfer without concern for iatrogenic risks to adequate gas transfer while minimizing lung injury. This change in focus, along with improved ventilator and multiorgan system management, has resulted in a significant improvement in patient outcomes. Despite this, a number of patients develop hypoxemic respiratory failure refractory to lung-protective ventilation (LPV). The intensivist then faces the dilemma of either persisting with LPV using adjuncts (neuromuscular blocking agents, prone positioning, recruitment maneuvers, inhaled nitric oxide, inhaled prostacyclin, steroids, and surfactant) or making a transition to rescue therapies such as high-frequency oscillatory ventilation (HFOV) and/or extracorporeal membrane oxygenation (ECMO) when both these modalities are at their disposal. The lack of quality evidence and potential harm reported in recent studies question the use of HFOV as a routine rescue option. Based on current literature, the role for venovenous (VV) ECMO is probably sequential as a salvage therapy to ensure ultraprotective ventilation in selected young patients with potentially reversible respiratory failure who fail LPV despite neuromuscular paralysis and prone ventilation. Given the risk profile and the economic impact, future research should identify the patients who benefit most from VV ECMO. These choices may be further influenced by the emerging novel extracorporeal carbon dioxide removal devices that can compliment LPV. Given the heterogeneity of acute respiratory distress syndrome, each of these modalities may play a role in an individual patient. Future studies comparing LPV, HFOV, and VV ECMO should not only focus on defining the patients who benefit most from each of these therapies but also consider long-term functional outcomes.
MeSH term(s)	Critical Care/methods ; Evidence-Based Medicine ; Extracorporeal Membrane Oxygenation/methods ; High-Frequency Ventilation/methods ; Humans ; Patient Selection ; Positive-Pressure Respiration/methods ; Pulmonary Gas Exchange ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Adult/physiopathology ; Respiratory Distress Syndrome, Adult/therapy ; Salvage Therapy
Language	English
Publishing date	2013-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2013.04.009
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Article ; Online: Acute cholecystitis complicating cardiac surgery: case series involving more than 16,000 patients.

Passage, Jurgen / Joshi, Pragnesh / Mullany, Daniel V

The Annals of thoracic surgery

2007 Volume 83, Issue 3, Page(s) 1096–1101

Abstract: Background: Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Its management remains controversial.: Methods: We reviewed all cases of calculous cholecystitis (CC) and acalculous cholecystitis (ACC) encountered at our ... ...

Abstract	Background: Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Its management remains controversial. Methods: We reviewed all cases of calculous cholecystitis (CC) and acalculous cholecystitis (ACC) encountered at our institution over the past 11 years. Data collection included preoperative variables, details of performed procedures, postoperative course, and outcome. Results: The overall incidence was 0.03% for CC and 0.08% for ACC (5 and 13 of 16,576 patients, respectively). Patients in the ACC group appeared to be sicker patients whereas most patients in the CC group had an uncomplicated recovery from cardiac surgery. The diagnosis was straightforward with typical presentation and ultrasonographic findings in the CC group. In the ACC group, the presentation was less specific, and although useful as diagnostic tool, ultrasonography findings were not as consistent as in the CC group. In the CC group, 3 patients underwent surgery, and 2 patients were treated conservatively. One patient died of cardiac causes after uncomplicated cholecystectomy. In the ACC group, 7 patients were treated medically and 6 patients underwent surgery. The overall mortality was 23% (3 patients). All deaths occurred in patients treated surgically. Conclusions: Given the low incidence of CC, we do not recommend preoperative screening or intervention for cholelithiasis. Treatment should be according to established guidelines. Patients with ACC, without overt peritonitis, should initially be treated conservatively with appropriate antibiotics. However, failure of significant improvement within 48 hours or a worsening clinical picture should lead to surgical intervention.
MeSH term(s)	Adolescent ; Adult ; Aged ; Australia/epidemiology ; Cardiac Surgical Procedures/adverse effects ; Cholecystectomy/mortality ; Cholecystitis, Acute/epidemiology ; Cholecystitis, Acute/etiology ; Cholecystitis, Acute/physiopathology ; Cholecystitis, Acute/therapy ; Cholecystolithiasis/epidemiology ; Cholecystolithiasis/etiology ; Cholecystolithiasis/physiopathology ; Cholecystolithiasis/therapy ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Severity of Illness Index ; Ultrasonography
Language	English
Publishing date	2007-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2006.09.048
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Article ; Online: A prospective pilot study evaluating the 'cardiac decompensation score' in the setting of intraaortic balloon counterpulsation.

Lewis, Peter A / Bartlett, Harry / Townsend, Shane / Courtney, Mary D / Mullany, Daniel V / Coyer, Fiona M

Intensive & critical care nursing

2011 Volume 27, Issue 1, Page(s) 31–36

Abstract: The study objective was to determine whether the 'cardiac decompensation score' could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only ... ...

Abstract	The study objective was to determine whether the 'cardiac decompensation score' could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p<0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p=0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p=0.024). This pilot study indicates the 'cardiac decompensation score' to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Heart Failure/diagnosis ; Heart Failure/mortality ; Heart Failure/therapy ; Hospital Mortality ; Humans ; Intra-Aortic Balloon Pumping/methods ; Male ; Middle Aged ; Monitoring, Physiologic ; Observer Variation ; Pilot Projects ; Prognosis ; Prospective Studies ; Queensland/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Severity of Illness Index ; Single-Blind Method ; Statistics, Nonparametric ; Survival Rate ; Treatment Outcome
Language	English
Publishing date	2011-02
Publishing country	Netherlands
Document type	Journal Article ; Validation Studies
ZDB-ID	1105892-4
ISSN	1532-4036 ; 0964-3397
ISSN (online)	1532-4036
ISSN	0964-3397
DOI	10.1016/j.iccn.2010.10.001
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Article ; Online: Risk factors and survival in patients with respiratory failure after cardiac operations.

Bailey, Michael L / Richter, Sven M / Mullany, Daniel V / Tesar, Peter J / Fraser, John F

The Annals of thoracic surgery

2011 Volume 92, Issue 5, Page(s) 1573–1579

Abstract: Background: Respiratory failure is a known complication of cardiac operations and contributes to postoperative morbidity and death. This study assessed the relevance of risk factors in the development of respiratory failure, defined as postoperative ... ...

Abstract	Background: Respiratory failure is a known complication of cardiac operations and contributes to postoperative morbidity and death. This study assessed the relevance of risk factors in the development of respiratory failure, defined as postoperative ventilation exceeding 48 hours, and looked at the effect of respiratory failure on short-term and long-term mortality rates. Methods: De-identified data for patients who underwent cardiac surgical procedures at The Prince Charles Hospital between January 2002 and December 2007 were collected prospectively and analyzed using logistic regression to identify significant risk factors associated with respiratory failure. Long-term mortality data were analyzed for patients who underwent operations between 1994 and 2005 using Kaplan-Meier survival curves. Results: The risk factor analysis included 7,440 patients. Identified risk factors for respiratory failure included critical preoperative state, neurologic dysfunction, poor left ventricular function, active endocarditis, chronic obstructive pulmonary disease, elevated preoperative creatinine, previous cardiac operation, and age. Survival was assessed in 18,488 patients and demonstrated increased short-term and long-term mortality rates when respiratory failure developed and increased mortality rates with increasing duration of respiratory failure. Conclusions: Respiratory failure is complication of cardiac operations associated with increased mortality and cost. Identification of patients at risk of respiratory failure may help select surgical candidates and aid resource planning and optimization.
MeSH term(s)	Aged ; Cardiac Surgical Procedures/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/mortality ; Risk Factors ; Survival Rate
Language	English
Publishing date	2011-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2011.04.019
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In stock of ZB MED Cologne/Königswinter

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Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito