title: Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey.
abstract: We conducted an international, prospective, 3-year questionnaire-based survey among 11 pulmonary hypertension centres to assemble data from patients with pulmonary arterial hypertension (PAH) undergoing noncardiac and nonobstetric surgery. Data were collected between July 2007 and June 2010 from 114 patients with PAH (70% female, mean age 57 years) who underwent major surgery. At the time of surgery, 43% were in functional class III/IV. 82% of the interventions were performed under general anaesthesia and 18% under spinal anaesthesia. Major complications occurred in seven (6.1%) of the patients, of whom four died, resulting in an overall perioperative mortality rate of 3.5%. The mortality rate was 15% (two out of 13) in emergency procedures, compared with 2% (two out of 101) in nonemergency procedures (p=0.01). Risk factors for major complications were an elevated right atrial pressure (OR 1.1, 95% CI 1.0-1.3; p=0.01), a 6-min walking distance <399 m at the last preoperative assessment (OR 2.2, 95% CI 1.1-3.7; p=0.04), the perioperative use of vasopressors (OR 1.5, 95% CI 1.2-2.7; p=0.03) and the need for emergency surgery (OR 2.4, 95% CI 1.4-3.6; p=0.01). Major surgery in patients with PAH continues to be a high-risk procedure, particularly when emergency interventions are needed.
authors.affiliation: Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Meyer
authors.forename: Vallerie V
authors.initials: VV
authors.lastname: McLaughlin
authors.forename: Hans-Juergen
authors.initials: HJ
authors.lastname: Seyfarth
authors.forename: Todd M
authors.initials: TM
authors.lastname: Bull
authors.forename: Carmine D
authors.initials: CD
authors.lastname: Vizza
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.forename: Ioana R
authors.initials: IR
authors.lastname: Preston
authors.forename: Joan A
authors.initials: JA
authors.lastname: Barberà
authors.forename: Paul M
authors.initials: PM
authors.lastname: Hassoun
authors.forename: Michael
authors.initials: M
authors.lastname: Halank
authors.forename: Xavier
authors.initials: X
authors.lastname: Jaïs
authors.forename: Nils
authors.initials: N
authors.lastname: Nickel
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology* / Q000601:surgery*; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Anaesthesia; hypertension; pulmonary; surgery; survival