title: Impact of intraoperative myocardial tissue acidosis on postoperative adverse outcomes and cost of care for patients undergoing prolonged aortic clamping during cardiopulmonary bypass.
abstract: BACKGROUND
  This study examined the impact of intraoperative myocardial acidosis and adverse postoperative outcomes on the cost of cardiac surgical care.
  
  
  METHODS
  Myocardial tissue pH corrected to 37 degrees C (pH(37C)) was measured in 162 patients with cross-clamp (XC) duration of 119 minutes or longer. Perioperative data and outcomes were collected prospectively. The Veterans Affairs cost accounting system was used to determine the cost of care in a subset of 57 patients.
  
  
  RESULTS
  Long XC duration was associated with significantly increased acidosis and adverse postoperative outcomes. The cost of care for patients with adverse outcomes was increased by 110% (P < .0001). Patients with acidosis at the end of reperfusion had significantly (P = .0470) increased costs of care. End reperfusion of myocardial tissue pH(37C) of less than 7.0, diabetes mellitus, and body surface area were significant determinants of postoperative adverse outcomes.
  
  
  CONCLUSIONS
  Intraoperative myocardial acidosis is a determinant of postoperative adverse outcomes and cost in cardiac surgery. Reducing XC duration and improving intraoperative myocardial protection should improve outcomes and reduce cost.
authors: Cardiothoracic Surgery (112), VA Boston Healthcare System, West Roxbury, MA 02132, USA.
authors: Christine M
authors: CM
authors: Healey
authors: Dharam J
authors: DJ
authors: Kumbhani
authors: Nancy A
authors: NA
authors: Healey
authors: Michael D
authors: MD
authors: Crittenden
authors: Stephen F
authors: SF
authors: Gibson
authors: Shukri F
authors: SF
authors: Khuri
mesh_terms: D000138:Acidosis / Q000191:economics / Q000209:etiology* / Q000517:prevention & control; D000368:Aged; D001011:Aorta / Q000601:surgery*; D009202:Cardiomyopathies / Q000191:economics / Q000209:etiology* / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003250:Constriction; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D013997:Time Factors