Patra Chitralekha, Chamaiah Gatti Prabhushankar, Panigrahi Ansuman
Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.
Indian Heart J. 2019 Jul-Aug;71(4):350-355. doi: 10.1016/j.ihj.2019.07.004. Epub 2019 Aug 6.
The present study aimed to assess the morbidity after cardiac surgery and identify the preoperative and intraoperative factors associated with postoperative morbidity.
A retrospective observational study was conducted including 362 adult patients aged 18-75 years who underwent open-heart surgery under cardiopulmonary bypass at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India, during the period from June 2016 to May 2017. Using a structured schedule, preoperative and intraoperative data were collected from the hospital's cardiac surgery database, whereas the postoperative data were collected from the intensive care unit (ICU) database and the hospital's clinical information system database.
Of 362 patients, 254 (70.2%) had at least one major complication, and the most frequently occurring complication was low cardiac output state (29.8%). The ICU length of stay (LOS) was for > 2 days in 23.2% of patients, and the hospital LOS was for > 7 days in almost 60% of the patients. Multivariate logistic regression analyses revealed that gender, type of surgery, body weight, blood lactate level at ICU admission, and 12-h blood lactate level were significant predictors of complications; gender and 24-h blood lactate level were significantly associated with the prolonged ICU LOS, whereas type of surgery and 24-h blood lactate level were significantly associated with prolonged hospital LOS.
The appropriate patient management strategy can be tailored based on the personal attributes, surgery type, and blood lactate level for individual patients undergoing cardiac surgery to reduce the likelihood of postoperative complications, ICU LOS, and hospital LOS.
本研究旨在评估心脏手术后的发病率，并确定与术后发病率相关的术前和术中因素。
进行了一项回顾性观察研究，纳入了2016年6月至2017年5月期间在印度班加罗尔的斯里贾亚德瓦心血管科学与研究机构接受体外循环下心内直视手术的362例18至75岁的成年患者。使用结构化表格，从医院的心脏手术数据库中收集术前和术中数据，而术后数据则从重症监护病房（ICU）数据库和医院的临床信息系统数据库中收集。
362例患者中，254例（70.2%）至少发生了一种主要并发症，最常见的并发症是低心排血量状态（29.8%）。23.2%的患者在ICU的住院时间（LOS）>2天，近60%的患者在医院的LOS>7天。多因素逻辑回归分析显示，性别、手术类型、体重、入住ICU时的血乳酸水平和12小时血乳酸水平是并发症的显著预测因素；性别和24小时血乳酸水平与ICU住院时间延长显著相关，而手术类型和24小时血乳酸水平与医院住院时间延长显著相关。
对于接受心脏手术的个体患者，可以根据其个人特征、手术类型和血乳酸水平制定合适的患者管理策略，以降低术后并发症、ICU住院时间和医院住院时间的可能性。
