Postoperative complications and mortality in older patients having non‐cardiac surgery at three Melbourne teaching hospitals

Backgound: This study was aimed at evaluating the presepsin and procalcitonin levels to predict adverse postoperative complications and mortality in cardiac surgery patients. Methods: A total of 122 cardiac surgery patients were enrolled for the study. Presepsin and procalcitonin levels were measured 48 h after the procedure. The primary endpoints were adverse renal, respiratory, and cardiovascular outcomes and mortality. Results: Presepsin and procalcitonin levels were significantly higher in patients with adverse renal and respiratory outcome (p < 0.001 and 0.0081). The presepsin levels were significantly higher in patients with adverse cardiovascular outcome (p = 0.023) and the procalcitonin values in patients with sepsis (p = 0.0013). Presepsin levels were significantly higher in patients who died during hospitalization (382 pg/mL, interquartile range [IQR] 243–717.5 vs. 1,848 pg/mL, IQR 998–5,451.5, p = 0.049). In addition, the predictive value for in-hospital, 30-days, and 6-months mortality was higher for presepsin, with a significant difference between the 2 biomarkers (p = 0.025, p = 0.035, p = 0.003; respectively). Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Although a positive trend was notable for presepsin and adverse renal outcome (area under the ROC [receiver operating characteristic] curves [AUC] of 0.760, 95% CI 0.673–0.833 versus procalcitonin: AUC 0.692; 95% CI 0.601–0.773): no statistically significant difference was evident between the AUC of the 2 biomarkers (p = 0.25). Conclusions: Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Also, presepsin possesses a better predictive value for in-hospital, 30-days, and 6-months mortality.

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Effect of the COVID-19 pandemic on complications and mortality of patients with cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01744-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xue Wang ◽

Heng Gao ◽

Zhanqin Zhang ◽

Chao Deng ◽

Yang Yan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Area Under The Curve ◽

Admission Rate ◽

Emergency Admission ◽

Control Group ◽

Short Term ◽

Short Term Mortality ◽

Complications And Mortality

Abstract Objectives The purpose of this study was to assess changes in cardiovascular disease severity, types, postoperative complications and prognosis during the COVID-19 pandemic and to explore possible influencing factors. Methods A total of 422 patients were enrolled in this study, and hospitalization and short-term follow-up data were retained. The patient population included 273 men and 149 women. Patients had a median (IQR) age of 54 (45–62) years and were divided into an observation group (130) and a control group (292), primarily according to severity of disease, disease types, baseline indexes, biochemical indexes, cardiac function indexes, complications and prognosis. Results During the COVID-19 pandemic, compared with the same period last year, there was a significant increase in patients with aortic dissection (27.69% vs 5.82%), a significant decrease in patients with valvular heart disease (43.08% vs 66.78%), and significantly increased emergency admission (50.00% vs 21.23%) and severity (54.62% vs 27.40%). Family company (76.37% vs 64.62%) was decreased, EuroSCORE [6.5 (2–9) vs 2 (0–5)] score, Pro-BNP [857.50 (241.00–2222.50) vs 542.40 (113.45–1776.75)] ng/L, six months mortality rate (18.46% vs 8.90%), and postoperative complications, including infected patients, atelectasis, pulmonary edema, and so on were increased, with longer length of stay in the ICU and hospital in COVID-19 pandemic. Survival analysis curve further demonstrated that it had an impact on the deaths of patients during the COVID-19 pandemic period. Through ROC analysis of the death factors of patients, it was concluded that Family company affected the death of patients, and the area under the curve was 0.654 (P < 0.05). Conclusions In this study, we found that the admission rate of critically ill patients with cardiovascular disease, complications of cardiac surgery, and short-term mortality of patients all exhibited a short-term increase, family company may be a risk factors for short-term mortality, that may be related to public pressure caused by the COVID-19 pandemic.

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Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

European Geriatric Medicine ◽

10.1007/s41999-021-00559-4 ◽

2021 ◽

Author(s):

Chun-Qing Li ◽

Chen Zhang ◽

Fan Yu ◽

Hao Kong ◽

Chun-Mei Deng

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Digestive Tract ◽

Older Patients ◽

Infectious Complications ◽

Increased Risk ◽

Life Threatening ◽

Digestive Tract Surgery ◽

Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

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Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199510000-00010 ◽

1995 ◽

Vol 77 (10) ◽

pp. 1551-1556 ◽

Cited By ~ 368

Author(s):

J D Zuckerman ◽

M L Skovron ◽

K J Koval ◽

G Aharonoff ◽

V H Frankel

Keyword(s):

Postoperative Complications ◽

Older Patients ◽

Complications And Mortality ◽

Operative Delay

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Effect of Prime Blood Storage Duration on Clinical Outcome After Pediatric Cardiac Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116682451 ◽

2017 ◽

Vol 8 (2) ◽

pp. 166-173

Author(s):

Arvind Kumar Bishnoi ◽

Pankaj Garg ◽

Kartik Patel ◽

Parth Solanki ◽

Jigar Surti ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Metabolic Profile ◽

Pediatric Patients ◽

Multiorgan Failure ◽

Univariate Analysis ◽

Storage Duration ◽

Packed Red Blood Cells ◽

Duration Of Storage ◽

Complications And Mortality

Background: In this study, we tested the hypothesis that in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) with blood prime, the storage duration of the packed red blood cells (PRBCs) used in prime led to differences in postoperative complications and metabolic profiles of the patients. Methods: For this prospective observational study we included 400 pediatric patients undergoing cardiac operations using CPB and requiring PRBCs prime. To study the effect of storage duration of PRBCs on postoperative morbidity, mortality, and metabolic profile, patients were divided into four groups (based on storage duration of PRBCs used in prime). Group 1: ≤7 days, group 2: 8 to 14 days, group 3: 15 to 21 days, and group 4: >21 days. Results: On univariate analysis, patients transfused with PRBCs stored >14 days had significantly higher incidence of postoperative complications, for example, liver dysfunction, hematological complications, sepsis, and multiorgan failure. However, after regression analysis and adjusting for the other confounder’s effects, no significant association was found between storage duration of PRBCs and postoperative complications and mortality. Metabolic profile of PRBCs was observed to become deranged with increasing duration of storage. This, however, improved to near physiological range early after the initiation of CPB and remained normal one hour after weaning from CPB, irrespective of the storage duration. Conclusion: Storage duration of PRBCs used for priming the pediatric CPB circuit neither affects the metabolic profile of the patients on CPB or early after surgery, nor it has any association with postoperative complications and mortality.

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Carotid Stenosis in Cardiac Surgery—No Difference in Postoperative Outcomes

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571851 ◽

2016 ◽

Vol 66 (03) ◽

pp. 255-260 ◽

Cited By ~ 3

Author(s):

Siavash Saadat ◽

Victor Dombrovskiy ◽

Kiersten Frenchu ◽

Jaya Kanduri ◽

Joseph Romero ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Carotid Stenosis ◽

Logistic Regression Analysis ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Increased Risk ◽

Complications And Mortality

Background Debate over revascularization of asymptomatic carotid stenosis before cardiac surgery is ongoing. In this study, we analyze cardiac surgery outcomes in patients with asymptomatic carotid stenosis at a single hospital. Methods In this study, 1,781 patients underwent cardiac surgery from January 2012 to June 2013; 1,357 with preoperative screening carotid duplex were included. Patient demographics, comorbidities, degree of stenosis, postoperative complications, and mortality were evaluated. Chi-square test and logistic regression analysis were performed. Results Asymptomatic stenosis was found in 403/1,357 patients (29.7%; 355 moderate and 48 severe). Patients with stenosis, compared with those without, were older (71.7 ± 11 vs. 66.3 ± 12 years; p < 0.01). Females were more likely to have stenosis (odd ratio, = 1.7; 95% confidence interval, 1.4–2.2); however, patients were predominantly male in both groups. There were no significant differences in the rates of mortality and postoperative complications, including stroke and transient ischemic attack (TIA). Postoperative TIA occurred in 3/1,357(0.2%); only one had moderate stenosis. Inhospital stroke occurred in 21/1,357 (1.5%) patients; stroke rates were 2.3% (8/355) with moderate stenosis and 2.1% (1/48) severe stenosis. There were 59/1,357 (4.3%) deaths; patients with stenosis had a mortality rate of 4.2% (17/403); however, no postoperative stroke lead to death. Multivariable logistic regression analysis with adjustment for age, gender, race, comorbidities, and postoperative complications did not show an impact of carotid stenosis on postoperative mortality and development of stroke after cardiac surgery. Conclusion This study suggests that patients with asymptomatic carotid stenosis undergoing cardiac surgery are not at increased risk of postoperative complications and mortality; thus, prophylactic carotid revascularization may not be indicated.

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