Intraoperative and postoperative risk factors for respiratory failure after coronary bypass

doi:10.1016/S0003-4975(02)04493-4

The Annals of Thoracic Surgery

Volume 75, Issue 3, March 2003, Pages 853-857

https://doi.org/10.1016/S0003-4975(02)04493-4 Get rights and content

Abstract

Background

Unlike preoperative events, the influence of intraoperative or postoperative events on respiratory failure after coronary artery bypass grafting (CABG) remains unclear. The purpose of this study was to identify intraoperative and postoperative risk factors that predispose respiratory impairment after CABG.

Methods

A single institutional database combined with a mandatory report submitted to the Cardiac Surgery Registry of the New York State Department of Health was used. A total of 8,802 consecutive patients who underwent primary CABG with or without a concomitant cardiac operation from January 1993 through December 2000 were included. Respiratory failure was defined as the need for postoperative mechanical ventilatory support longer than 72 hours. Univariate and multivariate logistic regression model was used in the analysis.

Results

Of 8,802 consecutive patients (6,234 males and 2,568 females) who underwent CABG with or without a concomitant operation, 491 patients (5.6%) suffered from postoperative respiratory failure. Although univariate analysis identified 39 statistically significant preoperative risk factors for post-CABG respiratory failure, only six preoperative risk factors were statistically significant by multivariate analysis (p < 0.001). CPB time (in 30 minutes increments) was the only validated intraoperative variable that increased the risk of postrespiratory failure (odds ratio [OR], 1.2; p less than 0.0001). Postoperative events contributing significantly to an increased risk of post-CABG respiratory failure were (1) sepsis and endocarditis (OR, 90.4; p < 0.0001), (2) gastrointestinal bleeding with or without infarction and perforation (OR, 38.8; p < 0.0001), (3) renal failure (OR, 30.7; p < 0.0001), (4) deep sternal wound infection (OR, 11.3; p < 0.0001), (5) new stroke, intraoperative at 24 hours (OR, 9.3; p < 0.0001), and (6) bleeding that required reoperation (OR, 5.5; p < 0.0001). All perioperative variables together accounted for only 28.6% (R²) of the variation.

Conclusions

Respiratory function after CABG is readily influenced by postoperative occurrence of extracardiac organ or system complications.

Section snippets

Patients and methods

All patient variables and perioperative events were obtained from the Cardiac Surgery Registry of the New York State Department of Health combined with our institutional perfusion database. A total of 8,802 consecutive patients (6,234 males and 2,568 females) who underwent CABG with or without a concomitant cardiac operation from January 1993 through December 2000 at Albany Medical Center (Albany, NY) were included in the analysis to determine their impact on postoperative respiratory failure.

Results

Of 8,802 patients undergoing CABG with or without a concomitant cardiac operation, 491 (5.6%) suffered from postoperative respiratory failure. These 491 patients with postoperative respiratory failure had 30-day survival of 75.7%, whereas the remaining patients with any one or more postoperative complication other than respiratory failure had early survival of 90.0% (p < 0.05).

Table 1 shows univariate analysis of preoperative patient variables with their relationship to respiratory failure

Comment

Prolonged ventilatory support after cardiac operation occurs in 5% to 22% of patients [3]. Postoperative respiratory failure had been documented in 5.6% of our patients who underwent CABG with or without a concomitant cardiac operation. The preoperative risk factors associated with prolonged ventilation after CABG have been addressed in a number of studies. These studies have shown left ventricular dysfunction, COPD, reoperation, unstable angina, age, peripheral vascular disease, impaired renal

Acknowledgements

The authors express their gratitude to Bradley VanKeuren and Sandy Sheldrick for data collection.

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Original article: cardiovascularIntraoperative and postoperative risk factors for respiratory failure after coronary bypass

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Comment

Acknowledgements

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Chest

Chest

Chest

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Chest

Ann Thorac Surg

Chest

Am J Med

Original article: cardiovascular
Intraoperative and postoperative risk factors for respiratory failure after coronary bypass