Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.
Department of Anesthesia and Intensive Care, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy.
Medicina (Kaunas). 2023 Jul 26;59(8):1368. doi: 10.3390/medicina59081368.
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. 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. In the "preoperative model" predictors for mortality were advanced age ( < 0.001), New York Heart Association (NYHA) class ( < 0.001) and emergent surgery ( = 0.036); predictors for non-invasive mechanical ventilation were advanced age ( < 0.001), low ejection fraction ( = 0.023), higher body mass index ( < 0.001) and preoperative renal failure ( = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease ( = 0.007), preoperative kidney injury ( < 0.001) and NYHA class ( = 0.033). In the "surgery model" predictors for mortality were intraoperative inotropes ( = 0.003) and intraoperative intra-aortic balloon pump ( < 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 ( < 0.001), tracheostomy ( < 0.001), inotropes ( = 0.029) and PaO/FiO ratio at discharge ( = 0.028); predictors for non-invasive mechanical ventilation were kidney injury ( < 0.001), inotropes ( < 0.001), blood transfusions ( < 0.001) and PaO/FiO ratio at the discharge ( < 0.001). In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.
肺部并发症是心脏手术后发病率的主要原因。本研究的目的是建立预测术后肺功能障碍和死亡率的模型。这是一项单中心、观察性、回顾性研究。我们回顾性分析了 2003 年至 2015 年间接受各种类型心脏手术的 11285 例成年患者的数据。我们为住院死亡率、术后 ICU 肺部并发症和临床需要时的术后无创机械通气建立了逻辑预测模型。在“术前模型”中，死亡率的预测因素为年龄较大（<0.001）、纽约心脏协会（NYHA）分级（<0.001）和急诊手术（=0.036）；无创机械通气的预测因素为年龄较大（<0.001）、射血分数较低（=0.023）、体重指数较高（<0.001）和术前肾功能衰竭（=0.043）；术后肺部并发症的预测因素为术前慢性阻塞性肺疾病（=0.007）、术前肾功能损伤（<0.001）和 NYHA 分级（=0.033）。在“手术模型”中，死亡率的预测因素为术中正性肌力药（=0.003）和术中主动脉内球囊泵（<0.001），这也预测了术后肺部并发症的发生。手术模型中没有特定的变量可以预测无创机械通气的使用。在“重症监护病房模型”中，死亡率的预测因素为术后肾功能损伤（<0.001）、气管切开术（<0.001）、正性肌力药（=0.029）和出院时 PaO/FiO 比值（=0.028）；无创机械通气的预测因素为肾功能损伤（<0.001）、正性肌力药（<0.001）、输血（<0.001）和出院时 PaO/FiO 比值（<0.001）。在这项回顾性研究中，我们确定了与心脏手术后死亡率和并发症相关的术前、术中及术后特征。
