title: Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery.
abstract: OBJECTIVE
  Perioperative risk associated with pulmonary hypertension (PH) in patients undergoing non-cardiac surgery (NCS) remains poorly defined. We report perioperative outcomes in a large cohort of patients undergoing NCS, comparing those with and without PH.
  
  
  METHODS
  Patients undergoing NCS at our institution between January 2002 and December 2006, were cross matched with a Right Heart Catheterization (RHC) database for the same period. Patients were excluded if they were <18 years old and if they underwent cardiac surgery prior to NCS or minor procedures using local anesthesia or sedation. Controls were defined as patients who underwent similar NCS with mean pulmonary arterial pressure (MPAP) ≤ 25 mmHg.
  
  
  RESULTS
  173 patients underwent RHC and NCS during the specified period and were included in the analysis. Of these 96 (55%) had PH. Mean pulmonary arterial pressure (p = 0.001), American Association of Anesthesiology Class (p = 0.02), and chronic renal insufficiency (p = 0.03) were determined as independent risk factors for post-operative morbidity. Patients with PH were more likely to develop congestive heart failure (p < 0.001; OR: 11.9), hemodynamic instability (p < 0.002), sepsis (p < 0.0005), and respiratory failure (p < 0.004). Patients with PH needed longer ventilatory support (p < 0.002), stayed longer in the ICU (p < 0.04), and were more frequently readmitted to the hospital within 30 days (p < 008; OR 2.4).
  
  
  CONCLUSIONS
  In addition to the traditionally known risk factors for outcomes after NCS such as coronary artery disease, diabetes mellitus, chronic renal insufficiency, American Society of Anesthesiology class, the presence of underlying PH can have a significant negative impact on perioperative outcomes.
authors.affiliation: Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Lerner College of Medicine, Desk A13, 9500 Euclid Avenue, Cleveland, OH 44195, USA. kawr@ccf.org
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.forename: Vinay
authors.initials: V
authors.lastname: Pasupuleti
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.forename: Tarek
authors.initials: T
authors.lastname: Hamieh
authors.forename: Esteban
authors.initials: E
authors.lastname: Walker
authors.forename: Omar A
authors.initials: OA
authors.lastname: Minai
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects*; D002407:Catheterization, Swan-Ganz; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012131:Respiratory Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome