Key result
ICU-based clinical model predicts post-cardiac surgery in-hospital mortality with ~0.90 AUROC.
Why the study?
Pulmonary complications are a leading cause of morbidity following cardiac surgery, prompting the development of models to predict postoperative lung dysfunction and mortality.
What are the preoperative, intraoperative, and postoperative predictors of mortality and pulmonary complications after cardiac surgery?
Observational (n=11,285)
No
What are the preoperative, intraoperative, and postoperative predictors of mortality and pulmonary complications after cardiac surgery?
Effect estimate: AUROC 0.90 (95% CI 0.87-0.94)
p-value: p=<0.0001
Specific preoperative, intraoperative, and postoperative factors can predict in-hospital mortality and pulmonary complications following cardiac surgery.
May aid postoperative mortality risk stratification after cardiac surgery; leaves open external validation before clinical use.
Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. Results: In the “preoperative model” predictors for mortality were advanced age (p < 0.001), New York Heart Association (NYHA) class (p < 0.001) and emergent surgery (p = 0.036); predictors for non-invasive mechanical ventilation were advanced age (p < 0.001), low ejection fraction (p = 0.023), higher body mass index (p < 0.001) and preoperative renal failure (p = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease (p = 0.007), preoperative kidney injury (p < 0.001) and NYHA class (p = 0.033). In the “surgery model” predictors for mortality were intraoperative inotropes (p = 0.003) and intraoperative intra-aortic balloon pump (p < 0.001), which also predicted the incidence of postoperative pulmonary complications. There were no specific variables in the surgery model predicting the use of non-invasive mechanical ventilation. In the “intensive care unit model”, predictors for mortality were postoperative kidney injury (p < 0.001), tracheostomy (p < 0.001), inotropes (p = 0.029) and PaO2/FiO2 ratio at discharge (p = 0.028); predictors for non-invasive mechanical ventilation were kidney injury (p < 0.001), inotropes (p < 0.001), blood transfusions (p < 0.001) and PaO2/FiO2 ratio at the discharge (p < 0.001). Conclusions: In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.
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Bignami et al. (2023) conducted an observational in Postoperative mortality and pulmonary complications after cardiac surgery (n=11,285). Perioperative clinical risk factors was evaluated on In-hospital mortality (Intensive Care Unit predictive model) (AUROC 0.90, 95% CI 0.87-0.94, p=<0.0001). A multivariate logistic model incorporating intensive care unit clinical variables effectively predicted in-hospital mortality following cardiac surgery with an AUROC of 0.90.
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