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Pulmonary hypertension: An important predictor of outcomes in patients undergoing non-cardiac surgery.
MedLine Citation:
PMID:  21195595     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Perioperative risk associated with pulmonary hypertension (PH) in patients undergoing non-cardiac surgery (NCS) remains poorly defined. We report perioperative outcomes in a large cohort of patients undergoing NCS, comparing those with and without PH. METHODS: Patients undergoing NCS at our institution between January 2002 and December 2006, were cross matched with a Right Heart Catheterization (RHC) database for the same period. Patients were excluded if they were <18 years old and if they underwent cardiac surgery prior to NCS or minor procedures using local anesthesia or sedation. Controls were defined as patients who underwent similar NCS with mean pulmonary arterial pressure (MPAP) ≤ 25 mmHg. RESULTS: 173 patients underwent RHC and NCS during the specified period and were included in the analysis. Of these 96 (55%) had PH. Mean pulmonary arterial pressure (p = 0.001), American Association of Anesthesiology Class (p = 0.02), and chronic renal insufficiency (p = 0.03) were determined as independent risk factors for post-operative morbidity. Patients with PH were more likely to develop congestive heart failure (p < 0.001; OR: 11.9), hemodynamic instability (p < 0.002), sepsis (p < 0.0005), and respiratory failure (p < 0.004). Patients with PH needed longer ventilatory support (p < 0.002), stayed longer in the ICU (p < 0.04), and were more frequently readmitted to the hospital within 30 days (p < 008; OR 2.4). CONCLUSIONS: In addition to the traditionally known risk factors for outcomes after NCS such as coronary artery disease, diabetes mellitus, chronic renal insufficiency, American Society of Anesthesiology class, the presence of underlying PH can have a significant negative impact on perioperative outcomes.
Authors:
Roop Kaw; Vinay Pasupuleti; Abhishek Deshpande; Tarek Hamieh; Esteban Walker; Omar A Minai
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-30
Journal Detail:
Title:  Respiratory medicine     Volume:  -     ISSN:  1532-3064     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2011-1-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
Affiliation:
Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Lerner College of Medicine, Desk A13, 9500 Euclid Avenue, Cleveland OH 44195, United States; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine, Desk A13, 9500 Euclid Avenue, Cleveland OH 44195, United States.
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