Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery

oleh: Elena Bignami, Marcello Guarnieri, Ilaria Giambuzzi, Cinzia Trumello, Francesco Saglietti, Stefano Gianni, Igor Belluschi, Nora Di Tomasso, Daniele Corti, Ottavio Alfieri, Marco Gemma

Format: Article
Diterbitkan: MDPI AG 2023-07-01

Deskripsi

<i>Background and Objectives:</i> Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. <i>Materials and Methods:</i> This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. <i>Results:</i> In the “preoperative model” predictors for mortality were advanced age (<i>p</i> < 0.001), New York Heart Association (NYHA) class (<i>p</i> < 0.001) and emergent surgery (<i>p</i> = 0.036); predictors for non-invasive mechanical ventilation were advanced age (<i>p</i> < 0.001), low ejection fraction (<i>p</i> = 0.023), higher body mass index (<i>p</i> < 0.001) and preoperative renal failure (<i>p</i> = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease (<i>p</i> = 0.007), preoperative kidney injury (<i>p</i> < 0.001) and NYHA class (<i>p</i> = 0.033). In the “surgery model” predictors for mortality were intraoperative inotropes (<i>p</i> = 0.003) and intraoperative intra-aortic balloon pump (<i>p</i> < 0.001), which also predicted the incidence of postoperative pulmonary complications. There were no specific variables in the surgery model predicting the use of non-invasive mechanical ventilation. In the “intensive care unit model”, predictors for mortality were postoperative kidney injury (<i>p</i> < 0.001), tracheostomy (<i>p</i> < 0.001), inotropes (<i>p</i> = 0.029) and PaO<sub>2</sub>/FiO<sub>2</sub> ratio at discharge (<i>p</i> = 0.028); predictors for non-invasive mechanical ventilation were kidney injury (<i>p</i> < 0.001), inotropes (<i>p</i> < 0.001), blood transfusions (<i>p</i> < 0.001) and PaO<sub>2</sub>/FiO<sub>2</sub> ratio at the discharge (<i>p</i> < 0.001). <i>Conclusions:</i> In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.