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. 2021 Jun;36(6):2045-2052.
doi: 10.1111/jocs.15471. Epub 2021 Mar 9.

Impact of postoperative complications after cardiac surgery on long-term survival

Siddharth Pahwa, Annalisa Bernabei  1 , Hartzell Schaff  1 , John Stulak  1 , Kevin Greason  1 , Alberto Pochettino  1 , Richard Daly  1 , Joseph Dearani  1 , Gabor Bagameri  1 , Katherine King  2 , Jason Viehman  2 , Juan Crestanello  1
Affiliations

Impact of postoperative complications after cardiac surgery on long-term survival

Siddharth Pahwa et al. J Card Surg. 2021 Jun.

Abstract

Purpose: The impact of postoperative complications on long-term survival is not well characterized. We sought to study the prevalence of postoperative complications after cardiac surgery and their impact on long-term survival.

Methods: Operative survivors (n = 26,221) who underwent coronary artery bypass grafting (CABG) (n = 13,054, 49.8%), valve surgery (n = 8667, 33.1%) or combined CABG and valve surgery (n = 4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for postoperative complications and long-term survival. Propensity-match analysis was performed between patients who did and did not have a postoperative complication. The associations between postoperative complications and survival were assessed using a Cox-proportional model.

Results: Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 postoperative complications were analyzed. Postoperative blood product use was the commonest (n = 12,397, 47.3%), followed by atrial fibrillation (n = 8399, 32.0%), prolonged ventilation (n = 2336, 8.9%), renal failure (n = 870, 3.3%), reoperation for bleeding (n = 859, 3.3%) and pacemaker/ICD insertion (n = 795, 3.0%). Stroke (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.36-1.77), renal failure (HR: 1.45; 95% CI: 1.33-1.58) and pneumonia (HR: 1.23; 95% CI: 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of postoperative complications increased.

Conclusions: Postoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long-term survival.

Keywords: long-term survival; postoperative complications.

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References

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