title: Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery.
abstract: OBJECTIVES Despite the seriousness of prolonged mechanical ventilation (PMV) as a postoperative complication, previously proposed risk prediction models were met with limited success. The purpose of this study was to identify perioperative variables associated with PMV in elective primary coronary bypass surgery. PMV was defined as the need for intubation and mechanical ventilation for >72 h, after completion of the operation. METHODS Between April 1997 and September 2010, 10 ,977 consecutive patients were retrospectively reviewed. A series of two multivariate logistic regression analyses were carried out to identify preoperative predictors of prolonged ventilation and the impact of operative variables. RESULTS PMV occurred in 215 (1.96%) patients; 119 (55.3%) of these underwent tracheostomy. At multivariate analysis, predictors included NYHA higher than class II (odds ratio [OR], 1.77; 95% confidence intervals [CI], 1.34-2.34), renal dialysis (OR, 5.5; 95% CI, 2.08-14.65), age at operation (OR, 1.04; 95% CI, 1.02-1.06), reduced FEV(1) (OR, 0.99; 95% CI, 0.98-0.99), body mass index >35 kg/m(2) (OR, 1.73; 95% CI, 1.14-2.63). On serial logistic regression analyses, operative variables added little to the discriminatory power of the model. Kaplan-Meier survival curves showed reduced survival among PMV patients (P < 0.001) with an improved survival in the tracheostomy subgroup. CONCLUSIONS PMV after coronary bypass is associated with a reduction in early and mid-term survival. Risk modelling for PMV remains problematic even when examining a more homogenous lower risk group.
authors.affiliation: Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. hzayed@hotmail.com
authors.forename: Hesham Z
authors.initials: HZ
authors.lastname: Saleh
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.forename: Omar
authors.initials: O
authors.lastname: Al-Rawi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yates
authors.forename: D Mark
authors.initials: DM
authors.lastname: Pullan
authors.forename: John A C
authors.initials: JA
authors.lastname: Chalmers
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fabri
mesh_terms: D000368:Aged; D060666:Airway Extubation; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome