Koskinen Atte, Aittokallio Jenni, Gunn Jarmo, Lehto Joonas, Relander Arto, Viikinkoski Emma, Vasankari Tuija, Jalkanen Juho, Hollmén Maija, Kiviniemi Tuomas O
Department of Anesthesiology, Intensive Care, Emergency Care, and Pain Medicine, University of Turku, Turku, Finland.
Division of Perioperative Services, Intensive Care Medicine, and Pain Management, Turku University Hospital, Turku, Finland.
JTCVS Open. 2023 Oct 30;16:602-609. doi: 10.1016/j.xjon.2023.10.017. eCollection 2023 Dec.
Patients undergoing heart surgery are at high risk of postoperative fluid accumulation due to long procedures and cardiopulmonary bypass. In the present study, we sought to investigate the prevalence of postoperative fluid accumulation and its relation to adverse events in patients undergoing cardiac surgery.
CAREBANK is prospective, single-center cohort study focusing on the adverse events after cardiac surgery. The study population was divided into 2 groups based on 5% postoperative weight gain. All the in-hospital adverse events are registered on the database. The end points of the present study were length of hospital stay, length of intensive care unit stay, occurrence of new-onset atrial fibrillation after hospital major bleeding episodes major cardiac events, cerebrovascular events, and death. Three-month and 1-year follow-up data also include all major adverse events.
Altogether 1001 adult cardiac surgery patients were enrolled. The most frequent operations were coronary artery bypass grafting (56.3%). Five hundred fifty-four out of 939 (59.0%) patients had ≥5% weight gain during index hospitalization. Patients with a weight gain ≥5% were more likely to be women, have lower body mass index, had heart failure, and more often had preoperative atrial fibrillation. In-hospital period fluid accumulation was associated with reoperation due bleeding and longer total hospital stay. At 3 months' follow-up, weight gain 5% or more was associated with increased occurrence of new-onset atrial fibrillation, this was not reflected in the occurrence of strokes, transient ischemic attacks, or myocardial infarctions.
Postoperative fluid excess is associated with adverse outcomes in cardiac surgery. Women, low-weight patients, and patients with cardiac failure or atrial fibrillation are prone to perioperative fluid accumulation.
由于手术时间长和体外循环，接受心脏手术的患者术后发生液体潴留的风险很高。在本研究中，我们试图调查心脏手术患者术后液体潴留的发生率及其与不良事件的关系。
CAREBANK是一项前瞻性、单中心队列研究，重点关注心脏手术后的不良事件。根据术后体重增加5%将研究人群分为两组。所有住院期间的不良事件都记录在数据库中。本研究的终点包括住院时间、重症监护病房住院时间、医院大出血事件后新发房颤的发生、重大心脏事件、脑血管事件和死亡。3个月和1年的随访数据也包括所有主要不良事件。
共纳入1001例成年心脏手术患者。最常见的手术是冠状动脉搭桥术（56.3%）。939例患者中有554例（59.0%）在首次住院期间体重增加≥5%。体重增加≥5%的患者更可能为女性，体重指数较低，患有心力衰竭，且术前房颤更为常见。住院期间的液体潴留与因出血而再次手术和总住院时间延长有关。在3个月的随访中，体重增加5%或更多与新发房颤的发生率增加有关，这在中风、短暂性脑缺血发作或心肌梗死的发生率中未得到体现。
心脏手术中术后液体过多与不良结局相关。女性、低体重患者以及心力衰竭或房颤患者围手术期容易发生液体潴留。
