Journal of cardiothoracic and vascular anesthesia · 2015
Rate of Major Anesthetic-Related Outcomes in the Intraoperative and Immediate Postoperative Period After Cardiac Surgery.
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Brovman Ethan Y, Gabriel Rodney A, Lekowski Robert W, Dutton Richard P, Urman Richard D
Аннотация
OBJECTIVES: To examine anesthesia-centered outcomes in a large cohort of patients undergoing coronary artery bypass grafting (CABG) or valvular heart surgery.
DESIGN: A retrospective study with univariate and multivariate logistic regression to identify independent predictors for mortality.
SETTING: Diverse setting including university, small, medium, and large community hospitals.
PARTICIPANTS: All patients undergoing CABG or valve surgery in the National Anesthesia Clinical Outcomes Registry (NACOR) from the Anesthesia Quality Institute.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Common anesthesia-centered outcomes including arrhythmia, cardiac arrest, death, hemodynamic instability, hypotension, inadequate pain control, nausea/vomiting, seizure, stroke, reintubation and transfusion were reported. All outcomes, consistent with NACOR data entry, were defined as occurring intraoperatively or during phase I or II recovery in the PACU. Death occurred in 0.15% of CABGs and 0.23% of valve surgeries. Age less than 18, American Society of Anesthesiologists physical status (ASA PS) classification of 5, and mean case duration greater than 6 hours were associated with increased mortality (p<0.05). The presence of a board-certified anesthesiologist was associated with decreased odds for mortality.
CONCLUSIONS: Death was a rare outcome in this cohort, reflecting the infrequent occurrence of intraoperative or immediate postoperative death. The presence of a board-certified anesthesiologist represented a modifiable risk factor for reducing mortality risk.
DESIGN: A retrospective study with univariate and multivariate logistic regression to identify independent predictors for mortality.
SETTING: Diverse setting including university, small, medium, and large community hospitals.
PARTICIPANTS: All patients undergoing CABG or valve surgery in the National Anesthesia Clinical Outcomes Registry (NACOR) from the Anesthesia Quality Institute.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Common anesthesia-centered outcomes including arrhythmia, cardiac arrest, death, hemodynamic instability, hypotension, inadequate pain control, nausea/vomiting, seizure, stroke, reintubation and transfusion were reported. All outcomes, consistent with NACOR data entry, were defined as occurring intraoperatively or during phase I or II recovery in the PACU. Death occurred in 0.15% of CABGs and 0.23% of valve surgeries. Age less than 18, American Society of Anesthesiologists physical status (ASA PS) classification of 5, and mean case duration greater than 6 hours were associated with increased mortality (p<0.05). The presence of a board-certified anesthesiologist was associated with decreased odds for mortality.
CONCLUSIONS: Death was a rare outcome in this cohort, reflecting the infrequent occurrence of intraoperative or immediate postoperative death. The presence of a board-certified anesthesiologist represented a modifiable risk factor for reducing mortality risk.