Intraoperative myocardial acidosis as a risk for hospital readmission after cardiac surgery.
BACKGROUND
This study elucidates the relationship between intraoperative myocardial acidosis/ischemia and the risk of unplanned hospital readmissions within 30 days and 6 months after cardiac surgery.


METHODS
Myocardial tissue pH (corrected to 37 degrees C: pH(37C)) was monitored in 221 patients during cardiac surgery. Regional myocardial acidosis was defined in terms of specific pH thresholds.


RESULTS
Fourteen percent and 27% of the patients were readmitted within 30 days and 6 months postoperatively, respectively. The mean number of readmissions was 1.67 +/- 1.24; pH(37C) <6.85 at the end of cardiopulmonary bypass (CPB) was identified as the threshold most significantly associated with readmission. This threshold was associated with a 6-fold increased risk of readmission within 30 days and a 5-fold increased risk within 6 months.


CONCLUSIONS
Persistent regional myocardial acidosis after weaning from CPB independently determines unplanned readmission rates up to 6 months postoperatively. This study underscores the importance of avoiding myocardial tissue acidosis during cardiac surgery.
Kumbhani
Dharam J
DJ
Surgical Service, VA Boston Healthcare System, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Healey
Nancy A
NA
Thatte
Hemant S
HS
Birjiniuk
Vladimir
V
Crittenden
Michael D
MD
Treanor
Patrick R
PR
Khuri
Shukri F
SF
D000138:Acidosis / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007431:Intraoperative Complications / Q000401:mortality / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000517:prevention & control*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012372:ROC Curve; D012307:Risk Factors