Impact of intraoperative myocardial tissue acidosis on postoperative adverse outcomes and cost of care for patients undergoing prolonged aortic clamping during cardiopulmonary bypass

American Journal of Surgery
Christine M HealeyShukri F Khuri

Abstract

This study examined the impact of intraoperative myocardial acidosis and adverse postoperative outcomes on the cost of cardiac surgical care. Myocardial tissue pH corrected to 37 degrees C (pH(37C)) was measured in 162 patients with cross-clamp (XC) duration of 119 minutes or longer. Perioperative data and outcomes were collected prospectively. The Veterans Affairs cost accounting system was used to determine the cost of care in a subset of 57 patients. Long XC duration was associated with significantly increased acidosis and adverse postoperative outcomes. The cost of care for patients with adverse outcomes was increased by 110% (P < .0001). Patients with acidosis at the end of reperfusion had significantly (P = .0470) increased costs of care. End reperfusion of myocardial tissue pH(37C) of less than 7.0, diabetes mellitus, and body surface area were significant determinants of postoperative adverse outcomes. Intraoperative myocardial acidosis is a determinant of postoperative adverse outcomes and cost in cardiac surgery. Reducing XC duration and improving intraoperative myocardial protection should improve outcomes and reduce cost.

References

Jul 1, 1995·Journal of Cardiac Surgery·A C CernaianuA J DelRossi
Jun 1, 1995·The Thoracic and Cardiovascular Surgeon·Y LouagieJ C Schoevaerdts
Jan 1, 1995·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·R L KalishL I Iezzoni
Jun 1, 1997·The Thoracic and Cardiovascular Surgeon·M DeiwickH H Scheld
Mar 7, 1998·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·J HerlitzB Lindelöw
Apr 27, 1999·Medical Care·P G Barnett, J H Rodgers
Oct 4, 2000·The Annals of Thoracic Surgery·S MaWhinneyA L Shroyer
Sep 27, 2001·World Journal of Surgery·C ByhahnK Westphal
Apr 21, 2004·Medical Care Research and Review : MCRR·Paul G Barnett
Aug 10, 2004·Surgery·Dharam J KumbhaniShukri F Khuri
Nov 18, 2004·American Journal of Surgery·Dharam J KumbhaniShukri F Khuri
Oct 26, 2005·The Annals of Thoracic Surgery·Dharam J KumbhaniShukri F Khuri
Aug 25, 2006·The Annals of Thoracic Surgery·Peter K SmithEdward Verrier
May 30, 2007·The Journal of Thoracic and Cardiovascular Surgery·Dharam J KumbhaniShukri F Khuri

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Citations

Oct 16, 2010·International Journal of Clinical Practice·H Fürstenwerth
Sep 16, 2008·American Journal of Surgery·Laki J RousouShukri F Khuri
Aug 4, 2011·Expert Review of Cardiovascular Therapy·Edward GologorskyTomas A Salerno
Jul 11, 2021·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Pengmei GuoMingsheng Zhang
Jul 14, 2010·Current Opinion in Anaesthesiology

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