title: Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation.
abstract: As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.
authors.affiliation: From the *Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania; †Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut; and ‡Department of Biostatistics, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hollenbach
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dauer
authors.forename: Lars O
authors.initials: LO
authors.lastname: Sjoholm
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pathak
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Rappold
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000150:complications / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States