BJA Advance Access originally published online on June 18, 2007
British Journal of Anaesthesia 2007 99(2):184-190; doi:10.1093/bja/aem126
Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery
1 Department of Anaesthesiology
2 Cardiovascular Centre, Taichung Veterans General Hospital, Taichung, Taiwan
3 School of Medicine
4 Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan
5 Chung-Gang University College of Medicine
6 Chung-Gang Memorial Hospital, Taipei, Taiwan
7 Chung-Shang Medical University, Taichung, Taiwan
* Corresponding author: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, 407, Taiwan. E-mail: trliu{at}vghtc.gov.tw
Background: Whether and how pulmonary hypertension (PH) impacts perioperative outcome in non-cardiac surgery is incompletely understood.
Methods: From November 1999, all patients undergoing non-cardiac, non-local anaesthetic surgery and ever examined by echocardiography within 30 days before surgery were screened. Those having echocardiographic pulmonary artery systolic pressure >70 mm Hg were enrolled provided they were not already intubated. Case-matched peers with normal pulmonary pressures served as controls. Perioperative outcomes were compared between the two groups, and predictors of adverse perioperative outcomes were investigated by multivariate logistic regression analysis.
Results: From November 1999 to August 2004, a total of 62 patients (male 38, mean age 67 yr) with PH were found. Compared with the case-matched controls, patients with PH experienced equivalently smooth operative courses, but significantly more frequent postoperative heart failure (9.7 vs 0%, P = 0.028), delayed tracheal extubation (21 vs 3%, P = 0.004), and in-hospital deaths (9.7 vs 0%, P = 0.028). Multivariate regression analysis identified emergency surgery [odds ratio (OR), 44.738; P = 0.028], coronary artery disease (CAD; OR, 9.933; P = 0.042), and systolic pulmonary artery pressure (OR, 1.101; P = 0.026) as independent predictors of postoperative mortality and surgery-specific cardiac risk level (OR, 6.791; P = 0.033) and CAD (OR 6.546, P = 0.017) as predictors of morbidity.
Conclusion: PH is an important predictor of adverse cardiopulmonary outcome in non-cardiac surgery as reflected by markedly increased postoperative complications, especially in patients with coexistent high-risk clinical and surgical characteristics.
Keywords: complication, pulmonary hypertension; monitoring, echocardiography; surgery
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