title: Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients.
abstract: OBJECTIVE
  The aim of this study was to determine the effect of pulmonary artery catheterization on clinical outcomes after cardiac surgery in higher-risk patients.
  
  
  METHODS
  Retrospective national database analysis.
  
  
  METHODS
  U.S. hospitals.
  
  
  METHODS
  A weighted sample of 2,063,337 patients undergoing cardiac surgery identified from the Nationwide Inpatient Sample (NIS) from January 1, 2000 to December 31, 2010.
  
  
  METHODS
  Pulmonary artery catheterization.
  
  
  RESULTS
  Compared to patients who did not receive a pulmonary artery catheter, those who did on the whole were on average slightly older (66.6±11.9 years v 65.5±12.8 years, p<0.001), more likely to have pulmonary hypertension (7.5% v 5.1%, p<0.001), chronic obstructive pulmonary disease (24.6% v 20.7%, p<0.001), obesity (15.0% v 13.1%, p<0.001), and chronic renal failure (10.9% v 9.2%, p<0.001). In multivariate analysis, the risk of operative mortality in patients who underwent pulmonary artery catheterization was significantly higher than in those who did not (4.6% v 3.1%, p<0.001), adjusted OR 1.34 (95% CI 1.26-1.43, p<0.001). In propensity matched subgroup analysis operative mortality risk was higher in octogenarian patients (OR 1.24, p = 0.24), and patients with congestive heart failure (OR 1.39, p = 0.023) who underwent pulmonary artery catheterization. No significant difference in operative mortality was observed in low-risk patients according to whether or not they underwent pulmonary artery catheterization. The incidence of prolonged mechanical ventilation and length of stay>30 days was higher in patients who underwent pulmonary artery catheterization in all subgroups.
  
  
  CONCLUSIONS
  In contemporary practice pulmonary artery catheters do not appear to be associated with reductions in operative mortality or morbidity and are associated with increases in duration of ventilation and length of stay in the intensive care unit.
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Chiang
authors.affiliation: Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York.
authors.forename: Leila
authors.initials: L
authors.lastname: Hosseinian
authors.affiliation: Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York.
authors.forename: Amanda
authors.initials: A
authors.lastname: Rhee
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Cavallaro
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York. Electronic address: joanna.chikwe@mountsinai.org.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment / Q000639:trends; D012307:Risk Factors
keywords: benefits; cardiac surgery; complications; monitoring; pulmonary artery catheter; risks