title: Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery.
abstract: BACKGROUND
  Respiratory failure (RF) is a serious complication following heart surgery. The profile of patients referred for cardiac surgery has changed during the last decade, making prior investigations of RF after cardiac surgery less relevant to the current population. This study was designed to analyze the incidence, predictors of RF, and early and late outcomes following this complication in a large contemporary cardiac surgery population.
  
  
  METHODS
  We retrospectively analyzed prospectively collected data from the New York State Department of Health database including 5,798 patients undergoing cardiac surgery between January 1998 and December 2005. Patients with RF (intubation time > or = 72 h) were compared to patients without RF.
  
  
  RESULTS
  The incidence of RF was 9.1% (n = 529). The highest incidence of RF was observed following combined valve/coronary artery bypass graft (14.8%) and aortic procedures (13.5%). Multivariate analysis revealed preoperative and operative predictors of RF such as renal failure (odds ratio [OR], 2.3), aortic procedures (OR, 2.6), hemodynamic instability (OR, 3.2), and intraaortic balloon pump (OR, 2.6). The mortality rate following RF was 15.5% (n = 82), compared to 2.4% (n = 126) in the no-RF group (p < 0.001). Kaplan-Meier survival curves showed significantly poorer survival among RF patients (p < 0.001) compared to the no-RF group.
  
  
  CONCLUSIONS
  RF remains a serious and common complication following cardiac surgery, particularly in patients undergoing complex procedures. RF is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival. Future research efforts should focus on a more precise identification of patients at risk and the development of new treatment modalities that would potentially prevent the occurrence of this complication.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029-1028, USA. farzan.filsoufi@mountsinai.org
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012042:Registries; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology