Division of Medicine, Forrest General Hospital, Hattiesburg, Mississippi, USA.
Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
J Card Surg. 2022 Dec;37(12):4304-4315. doi: 10.1111/jocs.17020. Epub 2022 Oct 13.
We sought to determine utilization and outcomes of perioperative temporary mechanical circulatory support (tMCS) in the current practice of cardiac surgery.
tMCS is an evolving adjunct to cardiac surgery not fully characterized in contemporary practice.
Using the nationwide inpatient sample we retrospectively analyzed hospital discharge data between January 1, 2016 and December 31, 2019. ICD-10-CM procedure codes were used to identify and divide patient hospitalizations into those who had preoperative tMCS (pre-tMCS) versus tMCS instituted the day of surgery or afterwards (sd/post-tMCS).
In all, 1,383,520 hospitalizations met inclusion criteria. 86,445 (6.25%) had tMCS. tMCS was utilized in 8.74% of coronary artery bypass grafting (CABG), 2.58% of isolated valve, and 9.71% of valve/CABG; operations. 29,325 (33.9%) had pre-tMCS while 57,120 (66.1%) had sd/post-tMCS. The use of tMCS was associated with greater inpatient mortality (15.66% vs. 1.53%, p < .001), longer length of stay (LOS) (14.4 vs. 8.5 days, p < .001), and higher mean inflation-adjusted costs ($93,040 ± 1038 vs. $51,358 ± 296, p < .001) compared to no use. Inpatient mortality (5.98% vs. 20.63%, p < .001), LOS (13.87 vs. 14.68, p < .001), and cost ($82,621 ± 1152 SEM vs. $98,381 ± 1242) were all significantly lower with pre-tMCS compared to sd/post tMCS. When analyzed separately, mortality was higher with later utilization of tMCS (5.98% pre, 17.1% sd, and 49.05% postsurgical date insertion, p < .001).
Perioperative tMCS is utilized in 6.25% of modern cardiac surgery, with two-thirds of cases instituted on the day of surgery or afterwards. The use of tMCS is associated with significantly higher mortality, longer LOS, and higher costs. Among patients undergoing tMCS, earlier utilization is associated with better outcomes.
本研究旨在确定当前心脏外科手术中围手术期临时机械循环支持（tMCS）的应用情况和结局。
tMCS 是心脏外科手术中的一种辅助手段，目前尚未在当代实践中得到充分描述。
本研究使用全国住院患者样本，回顾性分析了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间的住院患者数据。ICD-10-CM 手术代码用于识别并将患者的住院情况分为术前接受 tMCS（术前 tMCS）和手术当天或之后（手术当天或之后 tMCS）接受 tMCS 的患者。
共有 1383520 例符合纳入标准的住院患者。其中 86445 例（6.25%）接受了 tMCS。tMCS 在冠状动脉旁路移植术（CABG）中占 8.74%，单纯瓣膜手术中占 2.58%，瓣膜/CABG 手术中占 9.71%。29325 例（33.9%）接受了术前 tMCS，57120 例（66.1%）接受了手术当天或之后的 tMCS。tMCS 的使用与更高的住院死亡率（15.66% vs. 1.53%，p<0.001）、更长的住院时间（14.4 天 vs. 8.5 天，p<0.001）和更高的平均通胀调整后费用（93040 美元±1038 美元 vs. 51358 美元±296 美元，p<0.001）相关，而不是不使用 tMCS。与不使用 tMCS 相比，住院死亡率（5.98% vs. 20.63%，p<0.001）、住院时间（13.87 天 vs. 14.68 天，p<0.001）和费用（82621 美元±1152 美元 SEM vs. 98381 美元±1242 美元）均显著降低。单独分析时，tMCS 延迟使用的死亡率更高（术前 5.98%，手术当天 17.1%，术后日期插入 49.05%，p<0.001）。
围手术期 tMCS 在现代心脏外科手术中的应用率为 6.25%，其中三分之二的病例是在手术当天或之后进行的。tMCS 的使用与更高的死亡率、更长的住院时间和更高的费用相关。在接受 tMCS 的患者中，早期使用与更好的结局相关。
