Volume 1 Supplement 1

17th International Symposium on Intensive Care and Emergency Medicine

Open Access

Postoperative complications following cardiac surgery with cardiopulmonary bypass

  • DM Atwell1,
  • I Welsby1,
  • WD White1,
  • SA King1 and
  • MG Mythen1
Critical Care19971(Suppl 1):P103

https://doi.org/10.1186/cc85

Published: 1 March 1997

Introduction

Cardiac surgery using cardiopulmonary bypass (CPB) is associated with a low mortality, and planned hospital stays of less than 7 days imply a low incidence of major morbidity. We challenge this notion, having observed considerable morbidity attributable to low grade organ dysfunction; the purpose of this study was to quantify postoperative morbidity.

Methods

A retrospective analysis of prospectively collected data on all adult cardiac surgery patients presenting at the Duke Heart Center 1993-1995. Thirty-one named complications were recorded and described as patients cardiac or non-cardiac (further ascribed to specific organs) and the hospital lengths of stay (Hlos) associated with each named complication was noted.

Results

See tables.

Discussion

The median and mode Hlos support the impression that the postoperative course is uncomplicated and routine. However, morbidity following cardiac surgery (37% of patients) is common and a significant proportion is non-cardiac. Of note, 25% of patients remain in hospital > 8 days, most with some manifestations of organ dysfunction. The caremap structure for postoperative cardiac patients at Duke aims to limit Hlos to < 7 days; to stay beyond 7 days at Duke is invariably associated with serious morbidity, so for a significant minority of patients, recovery from cardiac surgery is far from uneventful. The incentives for interventions designed to reduce such morbidity and its associated increased cost are huge [1].
Table 1

Demographics

 

CABG

Valve

Combined

Male

Female

Total

n =

2106

309

186

1652

949

261

%

81%

12%

12%

7%

36%

100%

The range of Hlos in survivors is 5-112 days; the mean is 8; the median 6; the mode 5 and the standard deviation 7.4 days. Twenty-five percent of patients stay longer than 8 days.

Table 2

Mortality and morbidity

 

Died

Lived

Anycomp

No comp

Total

n =

91

2509

964

1637

2601

%

3.50%

96.50%

37%

63%

100%

Overall, complications occurred in 37% of patients. Arrhythmias (predominantly atrial) rank highest but of the 10 commonest complications resulting in a Hlos > 7 days, seven are non-cardiac. Regarding organ specific complications, the five commonest prolonging Hlos > 7 days rank: cardiac, lung, renal, brain, gut.

Authors’ Affiliations

(1)
Department of Anesthesiology, Duke University Medical Center

References

  1. Mythen MG, Webb AR: . Arch Surg. 1995, 130: 423-429.PubMedView ArticleGoogle Scholar

Copyright

© Current Science Ltd 1997

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