The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study
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REPORTS OF ORIGINAL INVESTIGATIONS
The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study Sheela Xavier, MBBS, MSc . Colleen M. Norris, PhD . Amanda Ewasiuk, MSc . Demetrios J. Kutsogiannis, MD, MPH . Sean M. Bagshaw, MD, MSc . Sean van Diepen, MD, MSc . Derek R. Townsend, MD . Jayan Negendran, MD, PhD . Constantine J. Karvellas, MD, SM, FRCPC Received: 20 January 2019 / Revised: 12 July 2019 / Accepted: 24 September 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. The therapeutic outcome of major cardiac surgery is significantly poorer in patients with cirrhosis compared with patients without cirrhosis. To address this, we aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes. Methods A historical cohort analysis of patients undergoing cardiac surgery at the University of Alberta Hospital from January 2004 to December 2014 was used to identify and propensity score-match 60 patients with cirrhosis to 310 patients without cirrhosis. The
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01493-7) contains supplementary material, which is available to authorized users. S. Xavier, MBBS, MSc A. Ewasiuk, MSc D. J. Kutsogiannis, MD, MPH S. M. Bagshaw, MD, MSc Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2X8, Canada C. M. Norris, PhD Faculty of Nursing, University of Alberta, Edmonton, AB, Canada S. van Diepen, MD, MSc Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2X8, Canada
relationships between cirrhosis and i) mortality, ii) postoperative complications, and iii) requirement of healthcare resources were evaluated. Results Ten-year mortality was significantly higher in cirrhotic patients compared with propensity score-matched non-cirrhotic patients (40% vs 20%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3 to 2.9; P = 0.001). Cirrhotic patients had more complications (63% vs 48%; RR, 1.3; 95% CI, 1.05 to 1.7; P = 0.02), longer median [interquartile range (IQR)] intensive care unit stays (5 [3– 11] vs 2 [1–4] days; P \ 0.001), time on mechanical ventilation (median [IQR] 2 [1–5] vs 1 [0.5–1.2] days; P\ 0.001) and more frequently required renal replacement therapy (15% vs 6%; RR, 2.5; 95% CI, 1.2 to 5.2; P = 0.02) postoperatively. After adjusting for other covariates, presence of cirrhosis (adjusted odds ratio, 2.2; 95% CI, 1.1
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada J. Negendran, MD, PhD Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada C. J. Karvellas, MD, SM, FRCPC (&) Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2X8, Canada e-mail: [email protected] D
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