Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery
Open Access
- 18 June 2007
- journal article
- research article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 99 (2), 184-190
- https://doi.org/10.1093/bja/aem126
Abstract
Whether and how pulmonary hypertension (PH) impacts perioperative outcome in non-cardiac surgery is incompletely understood. 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. 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. 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
This publication has 36 references indexed in Scilit:
- ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)Journal of the American College of Cardiology, 2004
- Clinical classification of pulmonary hypertensionJournal of the American College of Cardiology, 2004
- ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary ArticleCirculation, 2003
- Pulmonary Vascular Effects of Propofol at Baseline, during Elevated Vasomotor Tone, and in Response to Sympathetic α- and β-Adrenoreceptor ActivationAnesthesiology, 2001
- Propofol Attenuates Acetylcholine-induced Pulmonary VasorelaxationAnesthesiology, 2000
- Intraoperative Hemodynamic Predictors of Mortality, Stroke, and Myocardial Infarction After Coronary Artery Bypass SurgeryAnesthesia & Analgesia, 1999
- Attenuated Hypoxic Pulmonary Vasoconstriction during Isoflurane Anesthesia Is Abolished by Cyclooxygenase Inhibition in Chronically Instrumented DogsAnesthesiology, 1996
- Isoflurane and the Pulmonary Vascular Pressure-Flow Relation at Baseline and during Sympathetic α- and β-Adrenoreceptor Activation in Chronically Instrumented DogsAnesthesiology, 1995
- Peripheral Vascular Effects of Thiopental and Propofol in Humans with Artificial HeartsAnesthesiology, 1991
- Complications associated with anaesthesiaa — prospective survey in FranceCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1986