Is Training in Cardiac Surgery Dangerous to the Patients? A Retrospective Study with 1071 Propensity Score-Matched Subjects

Abstract Background The occurrence of postoperative cognitive dysfunction(POCD) after major cardiac surgery is associated with an increase in perioperative mortality and morbidity. The increased regional cerebral oxygen saturation(rSO2) value is likely related to increased POCD due to oxidative stress. The incidence of POCD in relation to an increase in rSO2 values is not clinically known yet.Methods Among 3482 patients underwent cardiac surgery, 976 patients were allocated for this retrospective study. Of these, 230 patients (32.5%) were observed to have postoperative neurologic symptoms. After propensity score 1:2 ratio matching, a total of 690 patients were included in the analysis. Recorded data on occurrence of POCD from the postoperative period to predischarge were collected from the electronic records. Results The mean baseline rSO2 value was higher in the POCD (–) group than in the POCD (+) group (61.9 ± 9.6 vs 55.3 ± 11.4; P < 0.001). The mean overall minimum rSO2 value was lower in the POCD (+) group (52.2 ± 8.3 vs 48.3 ±10.5, P < 0.001). As compared with baseline, the POCD (+) group had significantly higher values in the CPB preweaning and CPB post-weaning periods (P < 0.001, respectively). There was a greater decrease in the overall minimum rSO2 values compared with baseline in the POCD (–) group (P < 0.001). The maximum mean rSO2 changes compared with baseline were higher in the POCD (+) group (adjusted odds ratio, 1.08; 95% confidence interval [CI], 1.04–1.11; P < 0.001). The AUROC for delta values of minimal compared with baseline values was 0.62 and the AUROC for the delta values of maximal compared with baseline values was 0.72.Conclusions Increased cerebral oximeter levels relative to baseline values has an effect on the development of POCD. Intraoperative oxidative damage was associated with increased POCD, and increased cerebral oximeter levels during cardiac surgery can also be a risk factor for POCD.

Download Full-text

Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis

PLoS ONE ◽

10.1371/journal.pone.0253459 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0253459

Author(s):

Johanneke Hartog ◽

Iman Mousavi ◽

Sandra Dijkstra ◽

Joke Fleer ◽

Lucas H. V. van der Woude ◽

...

Keyword(s):

Cardiac Surgery ◽

Retrospective Study ◽

Propensity Score ◽

Propensity Score Analysis ◽

Unintended Consequences ◽

Sensitivity Analyses ◽

Care Group ◽

Elective Cardiac Surgery ◽

Related Risk ◽

Chi Squared

Background The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications. Methods Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes. Results Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9–2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0–2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found. Conclusions Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results.

Download Full-text

Effect of changes in cerebral oximeter values during cardiac surgery on the incidence of postoperative neurocognitive deficits (POND): A retrospective study based on propensity score–matched analysis

PLoS ONE ◽

10.1371/journal.pone.0260945 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260945

Author(s):

Jin Hee Ahn ◽

Eun kyung Lee ◽

Doyeon Kim ◽

SeHee Kang ◽

Won-Jun Choi ◽

...

Keyword(s):

Oxidative Stress ◽

Cardiac Surgery ◽

Risk Factor ◽

Retrospective Study ◽

Propensity Score ◽

Neuronal Damage ◽

Characteristic Curve ◽

Neurocognitive Deficits ◽

Cerebral Oximeter ◽

The Mean

Objectives The occurrence of postoperative neurocognitive deficits(POND)after major cardiac surgery is associated with an increase in perioperative mortality and morbidity. Oxidative stress caused by oxygen can affect neuronal damage, which can lead to POND. Whether the intraoperative rSO2 value reflects oxidative stress and the associated incidence of POND is unknown. Methods Among 3482 patients undergoing cardiac surgery, 976 patients were allocated for this retrospective study. Of these, 230 patients (32.5%) were observed to have postoperative neurologic symptoms. After propensity score 1:2 ratio matching, a total of 690 patients were included in the analysis. Recorded data on the occurrence of POND from the postoperative period to predischarge were collected from the electronic records. Results The mean baseline rSO2 value was higher in the POND (–) group than in the POND (+) group. The mean overall minimum rSO2 value was lower in the POND (+) group (52.2 ± 8.3 vs 48.3 ± 10.5, P < 0.001). The mean overall maximum rSO2 values were not significantly different between the two groups (72.7 ± 8.3 vs 73.2 ± 9.2, P = 0.526). However, there was a greater increase in the overall maximum rSO2 values as compared with baseline in the POND (+) group (10.9 ± 8.2 vs 17.9 ± 10.2, P < 0.001). The degree of increase in the maximum rSO2 value was a risk factor affecting the occurrence of POND (adjusted odds ratio, 1.08; 95% confidence interval [CI], 1.04–1.11; P < 0.001). The areas under the receiver-operating characteristic curve for delta values of minimal and maximal compared with baseline values were 0.60 and 0.71, respectively. Conclusions Increased cerebral oximeter levels during cardiac surgery may also be a risk factor for POND. This is considered to reflect the possibility of oxidative neuronal damage, and further studies are needed in the future.

Download Full-text