TY - JOUR
T1 - Outcomes After Noncardiac Surgery for Patients with Pulmonary Hypertension
T2 - A Historical Cohort Study
AU - Deljou, Atousa
AU - Sabov, Moldovan
AU - Kane, Garvan C.
AU - Frantz, Robert P.
AU - DuBrock, Hilary M.
AU - Martin, David P.
AU - Schroeder, Darrell R.
AU - Johnson, Madeline Q.
AU - Weingarten, Toby N.
AU - Sprung, Juraj
N1 - Funding Information:
T.N. Weingarten consults with Medtronic (Minneapolis, MN); serves as the PRODIGY trial chairman of the Clinical Events Committee; and has received an unrestricted investigator-initiated grant from Merck & Co. (Kenilworth, NJ) and research equipment from Respiratory Motion Inc (Waltham, MA). J Sprung is an expert panelist on the Lung Protective Ventilation Forum sponsored by GE Healthcare (Chicago, IL). T.N. Weingarten consults with Medtronic (Minneapolis, MN); serves as the PRODIGY trial chairman of the Clinical Events Committee; and has received an unrestricted investigator-initiated grant from Merck & Co. (Kenilworth, NJ) and research equipment from Respiratory Motion Inc (Waltham, MA). J Sprung is an expert panelist on the Lung Protective Ventilation Forum sponsored by GE Healthcare (Chicago, IL).
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Objective: Pulmonary hypertension (PH) is a substantial preoperative risk factor. For this study, morbidity and mortality were examined after noncardiac surgery in patients with precapillary PH. Design: A retrospective cohort study. Setting: Quaternary medical center in Rochester, MN. Participants: Adults with PH undergoing noncardiac surgery. Interventions: None. Measurements and Main Results: The PH and surgical databases were reviewed from 2010 to 2017. Patients were excluded if PH was attributable to left-sided heart disease or they had undergone cardiac or transplantation surgeries. To assess whether PH-specific diagnostic or cardiopulmonary testing parameters were predictive of perioperative complications, generalized estimating equations were used. Of 196 patients with PH, 53 (27%) experienced 1 or more complications, including 5 deaths (3%) within 30 days. After adjustment for age and PH type, there were more complications in those undergoing moderate- to high-risk versus low-risk procedures (odds ratio [OR] 4.17 [95% confidence interval {CI} 2.07-8.40]; p < 0.001). After adjustment for age, surgical risk, and PH type, the complication risk was greater for patients with worse functional status (OR 2.39 [95% CI 1.19-4.78]; p = 0.01 for classes III/IV v classes I/II) and elevated serum N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) (OR 2.28 [95% CI 1.05-4.96]; p = 0.04 for ≥300 v <300 pg/mL). After adjusting for age, surgical risk, and functional status, elevated NT-proBNP remained associated with increased risk (OR 2.23 [95% CI 1.05-4.76]; p = 0.04). Conclusion: PH patients undergoing noncardiac surgery have a high frequency of complications. Worse functional status, elevated serum NT-proBNP, and higher-risk surgery are predictive of worse outcome.
AB - Objective: Pulmonary hypertension (PH) is a substantial preoperative risk factor. For this study, morbidity and mortality were examined after noncardiac surgery in patients with precapillary PH. Design: A retrospective cohort study. Setting: Quaternary medical center in Rochester, MN. Participants: Adults with PH undergoing noncardiac surgery. Interventions: None. Measurements and Main Results: The PH and surgical databases were reviewed from 2010 to 2017. Patients were excluded if PH was attributable to left-sided heart disease or they had undergone cardiac or transplantation surgeries. To assess whether PH-specific diagnostic or cardiopulmonary testing parameters were predictive of perioperative complications, generalized estimating equations were used. Of 196 patients with PH, 53 (27%) experienced 1 or more complications, including 5 deaths (3%) within 30 days. After adjustment for age and PH type, there were more complications in those undergoing moderate- to high-risk versus low-risk procedures (odds ratio [OR] 4.17 [95% confidence interval {CI} 2.07-8.40]; p < 0.001). After adjustment for age, surgical risk, and PH type, the complication risk was greater for patients with worse functional status (OR 2.39 [95% CI 1.19-4.78]; p = 0.01 for classes III/IV v classes I/II) and elevated serum N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) (OR 2.28 [95% CI 1.05-4.96]; p = 0.04 for ≥300 v <300 pg/mL). After adjusting for age, surgical risk, and functional status, elevated NT-proBNP remained associated with increased risk (OR 2.23 [95% CI 1.05-4.76]; p = 0.04). Conclusion: PH patients undergoing noncardiac surgery have a high frequency of complications. Worse functional status, elevated serum NT-proBNP, and higher-risk surgery are predictive of worse outcome.
KW - complication
KW - hypertension
KW - perioperative
KW - postoperative complications/mortality
KW - pulmonary hypertension
KW - pulmonary/mortality
KW - surgical procedures/operative
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U2 - 10.1053/j.jvca.2019.10.059
DO - 10.1053/j.jvca.2019.10.059
M3 - Article
C2 - 31791851
AN - SCOPUS:85076538984
SN - 1053-0770
VL - 34
SP - 1506
EP - 1513
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 6
ER -