Intraoperative physiologic variables and outcome in cardiac surgery: Part I. In-hospital mortality.
BACKGROUND
Risk stratification schemes have been developed to predict outcome of coronary artery bypass grafting (CABG) procedures, which are predominately based upon unalterable preoperative patient characteristics. The purpose of this study was to determine if minimum intraoperative hematocrit, maximum glucose concentration, mean arterial pressure on cardiopulmonary bypass, or duration of bypass influence risk-adjusted in-hospital mortality after CABG.


METHODS
Outcome data from 2,862 CABG patients were merged with intraoperative physiologic data. A preoperative mortality risk index was calculated for each patient. Variables found significant (p<0.05) by univariate logistic regression were tested in a multiple variable model to determine risk-adjusted association with mortality.


RESULTS
Overall mortality rate was 1.85%. The preoperative risk index was significantly associated with mortality (p = 0.0001). No significant association was present between mortality and intraoperative variables. Preexisting hypertension was an independent predictor of mortality after controlling for risk index and bypass duration.


CONCLUSIONS
Preexisting hypertension proved to be an independent predictor of mortality in our patient population. This study found no evidence to support the hypothesis that mean arterial pressure less than 50 mm Hg, lower hematocrit, or elevated glucose while on bypass increases in-hospital mortality.
Hill
S E
SE
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. hill0012@mc.duke.edu
van Wermeskerken
G K
GK
Lardenoye
J W
JW
Phillips-Bute
B
B
Smith
P K
PK
Reves
J G
JG
Newman
M F
MF
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis
D001786:Blood Glucose