Impact of pulmonary hypertension on the outcomes of noncardiac surgery : Predictors of perioperative morbidity and mortality

• Published in: Journal of the American College of Cardiology Vol. 45; no. 10; pp. 1691 - 1699
• Main Authors: RAMAKRISHNA, Gautam, SPRUNG, Juraj, RAVI, Barugur S, CHANDRASEKARAN, Krishnaswamy, MCGOON, Michael D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 17.05.2005; Elsevier Limited
• Subjects: Adult; Aged; Anesthesia; Anesthesia, General; Arrhythmias, Cardiac - mortality; Biological and medical sciences; Blood Pressure; Cardiology; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - mortality; Cardiovascular disease; Confidence intervals; Dopamine; Female; Heart attacks; Heart failure; Heart Failure - mortality; Hemodynamics - physiology; Hospitals; Humans; Hypertension, Pulmonary - mortality; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Pneumology; Postoperative Complications - mortality; Pulmonary arteries; Pulmonary Embolism - complications; Pulmonary Embolism - mortality; Pulmonary hypertension; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Respiratory Insufficiency - mortality; Risk Factors; Statistics as Topic; Surgery; Surgical Procedures, Operative; Prognosis; Respiratory disease; Predictor; Mortality; Prediction; Cardiovascular disease; Epidemiology; Phlebology; Pulmonary hypertension; Morbidity; Perioperative; Treatment; Surgery; Evolution; Circulatory system; Cardiology; Predictive factor
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.02.055

We sought to determine the predictors of short-term morbidity and mortality (< 30 days) after noncardiac surgery in patients with pulmonary hypertension (PH). Pulmonary hypertension is considered to be a significant preoperative risk factor. The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated with short-term morbidity and mortality. Of 1,276 patients in the PH database, 145 patients (73% female) met all study criteria. The mean age (+/-SD) was 60.1 +/- 16.0 years. Right ventricular systolic pressure (RVSP) (mean +/- SD) on the two-dimensional echocardiogram was 68 +/- 21 mm Hg. There were 60 patients (42%) who experienced one or more short-term morbid event(s) (1.8 events/patient experiencing any event). A history of pulmonary embolism (p = 0.01), New York Heart Association functional class > or = II (p = 0.02), intermediate- to high-risk surgery (p = 0.04), and duration of anesthesia > 3 h (p = 0.04) were independent predictors of short-term morbidity. There were 10 early deaths (7%). A history of pulmonary embolism (p = 0.04), right-axis deviation (p = 0.02), right ventricular (RV) hypertrophy (p = 0.04), RV index of myocardial performance > or = 0.75 (p = 0.03), RVSP/systolic blood pressure > or = 0.66 (p = 0.01), intraoperative use of vasopressors (p < 0.01), and anesthesia when nitrous oxide was not used (p < 0.01) were each associated with postoperative mortality. In patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes.