Postoperative complications following cardiac surgery with cardiopulmonary bypass

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

Table 2 Mortality and morbidity