Yuting Chiang1, Leila Hosseinian2, Amanda Rhee2, Shinobu Itagaki1, Paul Cavallaro1, Joanna Chikwe3. 1. Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York. 2. Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York. 3. Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York. Electronic address: joanna.chikwe@mountsinai.org.
Abstract
OBJECTIVE: The aim of this study was to determine the effect of pulmonary artery catheterization on clinical outcomes after cardiac surgery in higher-risk patients. DESIGN: Retrospective national database analysis. SETTING: U.S. hospitals. PARTICIPANTS: A weighted sample of 2,063,337 patients undergoing cardiac surgery identified from the Nationwide Inpatient Sample (NIS) from January 1, 2000 to December 31, 2010. INTERVENTIONS: Pulmonary artery catheterization. MEASUREMENTS AND MAIN RESULTS: Compared to patients who did not receive a pulmonary artery catheter, those who did on the whole were on average slightly older (66.6±11.9 years v 65.5±12.8 years, p<0.001), more likely to have pulmonary hypertension (7.5% v 5.1%, p<0.001), chronic obstructive pulmonary disease (24.6% v 20.7%, p<0.001), obesity (15.0% v 13.1%, p<0.001), and chronic renal failure (10.9% v 9.2%, p<0.001). In multivariate analysis, the risk of operative mortality in patients who underwent pulmonary artery catheterization was significantly higher than in those who did not (4.6% v 3.1%, p<0.001), adjusted OR 1.34 (95% CI 1.26-1.43, p<0.001). In propensity matched subgroup analysis operative mortality risk was higher in octogenarian patients (OR 1.24, p = 0.24), and patients with congestive heart failure (OR 1.39, p = 0.023) who underwent pulmonary artery catheterization. No significant difference in operative mortality was observed in low-risk patients according to whether or not they underwent pulmonary artery catheterization. The incidence of prolonged mechanical ventilation and length of stay>30 days was higher in patients who underwent pulmonary artery catheterization in all subgroups. CONCLUSIONS: In contemporary practice pulmonary artery catheters do not appear to be associated with reductions in operative mortality or morbidity and are associated with increases in duration of ventilation and length of stay in the intensive care unit.
OBJECTIVE: The aim of this study was to determine the effect of pulmonary artery catheterization on clinical outcomes after cardiac surgery in higher-risk patients. DESIGN: Retrospective national database analysis. SETTING: U.S. hospitals. PARTICIPANTS: A weighted sample of 2,063,337 patients undergoing cardiac surgery identified from the Nationwide Inpatient Sample (NIS) from January 1, 2000 to December 31, 2010. INTERVENTIONS: Pulmonary artery catheterization. MEASUREMENTS AND MAIN RESULTS: Compared to patients who did not receive a pulmonary artery catheter, those who did on the whole were on average slightly older (66.6±11.9 years v 65.5±12.8 years, p<0.001), more likely to have pulmonary hypertension (7.5% v 5.1%, p<0.001), chronic obstructive pulmonary disease (24.6% v 20.7%, p<0.001), obesity (15.0% v 13.1%, p<0.001), and chronic renal failure (10.9% v 9.2%, p<0.001). In multivariate analysis, the risk of operative mortality in patients who underwent pulmonary artery catheterization was significantly higher than in those who did not (4.6% v 3.1%, p<0.001), adjusted OR 1.34 (95% CI 1.26-1.43, p<0.001). In propensity matched subgroup analysis operative mortality risk was higher in octogenarian patients (OR 1.24, p = 0.24), and patients with congestive heart failure (OR 1.39, p = 0.023) who underwent pulmonary artery catheterization. No significant difference in operative mortality was observed in low-risk patients according to whether or not they underwent pulmonary artery catheterization. The incidence of prolonged mechanical ventilation and length of stay>30 days was higher in patients who underwent pulmonary artery catheterization in all subgroups. CONCLUSIONS: In contemporary practice pulmonary artery catheters do not appear to be associated with reductions in operative mortality or morbidity and are associated with increases in duration of ventilation and length of stay in the intensive care unit.
Authors: Mitali Stevens; Todd Davis; Sibyl H Munson; Apeksha V Shenoy; Boye L A Gricar; Halit O Yapici; Andrew D Shaw Journal: Clinicoecon Outcomes Res Date: 2021-02-05
Authors: J W Awori Hayanga; Philippe H Lemaitre; HelenMari Merritt-Genore; Nicholas R Teman; Nathalie Roy; Pablo G Sanchez; Jeffrey Javidfar; Laura Donahoe; Rakesh C Arora Journal: J Thorac Cardiovasc Surg Date: 2022-05-17 Impact factor: 6.439
Authors: Duraid Younan; T Mark Beasley; David C Pigott; C Blayke Gibson; John P Gullett; Jeffrey Richey; Jean-Francois Pittet; Ahmed Zaky Journal: Crit Ultrasound J Date: 2017-10-11
Authors: Andrew D Shaw; Michael G Mythen; Douglas Shook; David K Hayashida; Xuan Zhang; Jeffrey R Skaar; Sloka S Iyengar; Sibyl H Munson Journal: Perioper Med (Lond) Date: 2018-10-25