Hemodynamic monitoring in the elderly undergoing elective colon resection for cancer

Abstract

Controversy surrounds the use of pulmonary artery catheters (PACs). We evaluated the influence of preoperative hemodynamic monitoring and optimization on the outcome in elderly patients undergoing elective resection for colon cancer. We performed a retrospective analysis of all elderly patients (age > 65 years) who had undergone elective colon resection during 1985 to 1995. Sixty patients had preoperative insertion of PAC; 217 patients were managed without PAC. Charts were reviewed for Goldman's cardiac risk index (CRI), preoperative risk factors, and hospital mortality. On the basis of CRI the patients were divided into two groups (< 10 and > or = 10). There was no significant difference between PAC or no-PAC patients for age, previous myocardial infarction, congestive heart failure, hypertension, chronic obstructive pulmonary disease, renal insufficiency, hemoglobin, and albumin. There were 12 deaths (4.3%). CRI, which was a significant predictor of mortality in the no-PAC group (2.2% mortality for CRI < 10 vs 15.8% for CRI > or = 10; P < 0.001), was insignificant in the PAC group (2.5% mortality for CRI < 10 vs 5% for CRI > or = 10, P = not significant). Although preoperative optimization using PAC was not beneficial in the low-CRI group it resulted in a threefold reduction in mortality (5% vs 15.8%) in the high-CRI group. We conclude that preoperative optimization of cardiovascular function using a PAC is only beneficial in reducing mortality in high-risk (CRI > or = 10) elderly patients undergoing elective colon resection.