PREDICTORS OF IN-HOSPITAL MORTALITY FOR PATIENTS UNDERGOING REDO CARDIAC SURGERY: A SIRS SUBSTUDY
CCC ePoster Library. Gupta S. 10/26/19; 280546; 311
Dr. Saurabh Gupta
Dr. Saurabh Gupta
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Abstract
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BACKGROUND: Redo cardiac surgery accounts for about 8% of cardiac surgeries and carries approximately 10% risk of in-hospital mortality. Contemporary data regarding mortality after redo surgery and its predictors are limited, but may allow surgeons to identify patients at higher risk.

METHODS AND RESULTS: The Steroids in Cardiac Surgery (SIRS) trial assessed perioperative use of methylprednisolone. Of 7507 participants from 80 centres in 18 countries, 1214 underwent redo surgery. Using these patients as a cohort, we aimed to identify independent risk factors for in-hospital mortality. We created a logistic regression model using a forward step-wise entry model, with hypothesized and known risk factors for post-operative mortality: age, sex, prolonged cardiopulmonary bypass (CPB) time (>120 minutes), body mass index (BMI), EuroSCORE, treatment allocation (steroid or placebo), and operation type (coronary artery bypass grafting (CABG) only, CABG and valve, valve only, any aortic surgery, and miscellaneous). Follow-up was 99.9% complete at discharge. Only patients with complete follow-up were included in the model. Mean age was 64 years with 40% females. 64% of patients were overweight or obese, and 55% of patients had a prolonged CPB time. Unadjusted in-hospital mortality was 8.2% (100/1213). Significant risk factors for in-hospital mortality included: increase in age by five years (adjusted OR (aOR) 1.14, 95% CI [1.03–1.27]), female sex (aOR 3.13, 95% CI [1.98–4.96]), prolonged CPB time (aOR 4.15, 95% CI [2.44–7.05]), and increase in EuroSCORE by one unit (aOR 1.15, 95% CI [1.04–1.27]). Factors associated with a significantly lower risk for in-hospital mortality included: being overweight or obese (aOR 0.44, 95% CI [0.26–0.72] and aOR 0.52, 95% CI [0.27–0.99], respectively), and any aortic surgery (aOR 0.37, 95% CI [0.15–0.93]). There was a significant negative interaction between prolonged CPB time and EuroSCORE (p=0.001): the risk of mortality associated with a prolonged CPB time was higher with a lower EuroSCORE.

CONCLUSION: Age, EuroSCORE, female sex and prolonged CPB time were associated with increased in-hospital mortality in patients undergoing redo cardiac surgery. Overweight and obese patients were at a lower risk, consistent with the obesity paradox in cardiac surgery. The observed protective effect of aortic surgery may be related to surgeon expertise. The increased risk of mortality for patients with a lower EuroSCORE, but prolonged CPB time, likely represents surgical misadventure; a complication in the operation room for an otherwise relatively lower risk surgery.
BACKGROUND: Redo cardiac surgery accounts for about 8% of cardiac surgeries and carries approximately 10% risk of in-hospital mortality. Contemporary data regarding mortality after redo surgery and its predictors are limited, but may allow surgeons to identify patients at higher risk.

METHODS AND RESULTS: The Steroids in Cardiac Surgery (SIRS) trial assessed perioperative use of methylprednisolone. Of 7507 participants from 80 centres in 18 countries, 1214 underwent redo surgery. Using these patients as a cohort, we aimed to identify independent risk factors for in-hospital mortality. We created a logistic regression model using a forward step-wise entry model, with hypothesized and known risk factors for post-operative mortality: age, sex, prolonged cardiopulmonary bypass (CPB) time (>120 minutes), body mass index (BMI), EuroSCORE, treatment allocation (steroid or placebo), and operation type (coronary artery bypass grafting (CABG) only, CABG and valve, valve only, any aortic surgery, and miscellaneous). Follow-up was 99.9% complete at discharge. Only patients with complete follow-up were included in the model. Mean age was 64 years with 40% females. 64% of patients were overweight or obese, and 55% of patients had a prolonged CPB time. Unadjusted in-hospital mortality was 8.2% (100/1213). Significant risk factors for in-hospital mortality included: increase in age by five years (adjusted OR (aOR) 1.14, 95% CI [1.03–1.27]), female sex (aOR 3.13, 95% CI [1.98–4.96]), prolonged CPB time (aOR 4.15, 95% CI [2.44–7.05]), and increase in EuroSCORE by one unit (aOR 1.15, 95% CI [1.04–1.27]). Factors associated with a significantly lower risk for in-hospital mortality included: being overweight or obese (aOR 0.44, 95% CI [0.26–0.72] and aOR 0.52, 95% CI [0.27–0.99], respectively), and any aortic surgery (aOR 0.37, 95% CI [0.15–0.93]). There was a significant negative interaction between prolonged CPB time and EuroSCORE (p=0.001): the risk of mortality associated with a prolonged CPB time was higher with a lower EuroSCORE.

CONCLUSION: Age, EuroSCORE, female sex and prolonged CPB time were associated with increased in-hospital mortality in patients undergoing redo cardiac surgery. Overweight and obese patients were at a lower risk, consistent with the obesity paradox in cardiac surgery. The observed protective effect of aortic surgery may be related to surgeon expertise. The increased risk of mortality for patients with a lower EuroSCORE, but prolonged CPB time, likely represents surgical misadventure; a complication in the operation room for an otherwise relatively lower risk surgery.
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