Ethan Y Brovman1, Rodney A Gabriel1, Robert W Lekowski1, Richard P Dutton2, Richard D Urman3. 1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. 2. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA; Anesthesia Quality Institute, Schaumburg, IL. Electronic address: rurman@partners.org.
Abstract
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.
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.
Authors: Devan Darby Bartels; Mary Ellen McCann; Andrew J Davidson; David M Polaner; Elizabeth L Whitlock; Brian T Bateman Journal: Paediatr Anaesth Date: 2018-05-02 Impact factor: 2.556