Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery

Nathaniel R. Smilowitz, Andrew Armanious, Sripal Bangalore, Harish Ramakrishna, Jeffrey S. Berger

Research output: Contribution to journalArticle

Abstract

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 noncardiac surgery in the United States are unknown. Patients ≥18 years of age hospitalized for noncardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014. Pulmonary hypertension was defined by International Classification of Diseases, Ninth Revision diagnosis codes. The primary outcome was perioperative major adverse cardiovascular events (MACCE), defined as in-hospital death, myocardial infarction, or ischemic stroke. Among 17,853,194 hospitalizations for major noncardiac 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 nonfatal myocardial infarction (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 to 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.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StatePublished - Jan 1 2019

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Pulmonary Hypertension
Hospitalization
Myocardial Infarction
Intraoperative Monitoring
Perioperative Period
International Classification of Diseases
Health Care Costs
Patient Selection
Pulmonary Artery
Inpatients
Hemodynamics
Stroke
Demography
Morbidity
Pressure
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery. / Smilowitz, Nathaniel R.; Armanious, Andrew; Bangalore, Sripal; Ramakrishna, Harish; Berger, Jeffrey S.

In: American Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Smilowitz, Nathaniel R. ; Armanious, Andrew ; Bangalore, Sripal ; Ramakrishna, Harish ; Berger, Jeffrey S. / Cardiovascular Outcomes of Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery. In: American Journal of Cardiology. 2019.
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