title: Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality.
abstract: OBJECTIVE
  We sought to determine the predictors of short-term morbidity and mortality (< 30 days) after noncardiac surgery in patients with pulmonary hypertension (PH).
  
  
  BACKGROUND
  Pulmonary hypertension is considered to be a significant preoperative risk factor.
  
  
  METHODS
  The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated with short-term morbidity and mortality.
  
  
  RESULTS
  Of 1,276 patients in the PH database, 145 patients (73% female) met all study criteria. The mean age (+/-SD) was 60.1 +/- 16.0 years. Right ventricular systolic pressure (RVSP) (mean +/- SD) on the two-dimensional echocardiogram was 68 +/- 21 mm Hg. There were 60 patients (42%) who experienced one or more short-term morbid event(s) (1.8 events/patient experiencing any event). A history of pulmonary embolism (p = 0.01), New York Heart Association functional class > or = II (p = 0.02), intermediate- to high-risk surgery (p = 0.04), and duration of anesthesia > 3 h (p = 0.04) were independent predictors of short-term morbidity. There were 10 early deaths (7%). A history of pulmonary embolism (p = 0.04), right-axis deviation (p = 0.02), right ventricular (RV) hypertrophy (p = 0.04), RV index of myocardial performance > or = 0.75 (p = 0.03), RVSP/systolic blood pressure > or = 0.66 (p = 0.01), intraoperative use of vasopressors (p < 0.01), and anesthesia when nitrous oxide was not used (p < 0.01) were each associated with postoperative mortality.
  
  
  CONCLUSIONS
  In patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Ramakrishna
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.forename: Barugur S
authors.initials: BS
authors.lastname: Ravi
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: Michael D
authors.initials: MD
authors.lastname: McGoon
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001145:Arrhythmias, Cardiac / Q000401:mortality; D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality; D012131:Respiratory Insufficiency / Q000401:mortality; D012307:Risk Factors; D013223:Statistics as Topic; D013514:Surgical Procedures, Operative