Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices.
Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices.
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DOI：
10.1097/aln.0000000000001488
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发表时间：
2017-03
期刊：
影响因子：
8.8
通讯作者：
Engoren MC
中科院分区：
文献类型：
--
作者：
Mathis MR;Sathishkumar S;Kheterpal S;Caldwell MD;Pagani FD;Jewell ES;Engoren MC
带左心室辅助装置（LVAD）进行非心脏手术（NCS）的患者越来越常见;然而，对其结局知之甚少。因此，作者试图确定并发症的频率、风险因素和人员配置模式。我们在我们的学术三级护理中心进行了一项回顾性研究，调查了2006年至2015年接受NCS的所有成人LVAD患者。我们描述了NCS病例的围手术期概况，包括患者、LVAD、手术病例和麻醉特征，以及心脏/非心脏麻醉师的人员配备。通过单变量和多变量分析，我们研究了急性肾损伤（阿基）作为主要结局;次要结局包括提示LVAD血栓形成的血清乳酸脱氢酶（LDH）升高、术中出血并发症和术中低血压。我们还研究了主要的围手术期并发症和死亡率。246例患者接受了702例手术。在607例索引病例中，110例（18%）发生术后阿基，16例（2.6%）LDH升高。在具有完整血压数据的病例中，176例（27%）发生术中低血压。出血并发症45例（6.4%）。13例（5.3%）患者在手术后30天内死亡。与阿基相关的独立风险因素包括大手术（校正比值比[aOR] 4.4，95%置信区间[CI] 1.1-17.3，p = 0.03）和提示有创动脉管路监测的病例（aOR 3.6，95% CI 1.3-10.3，p = 0.02）或术前新鲜冷冻血浆输注（aOR 1.7，95% CI 1.1-2.8，p = 0.02）。术中低血压和阿基是因NCS就诊的LVAD患者中最常见的并发症;围手术期管理仍然是一项挑战。
Patients with left ventricular assist devices (LVADs) presenting for non-cardiac surgery (NCS) are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. We performed a retrospective study at our academic tertiary care center, investigating all adult LVAD patients undergoing NCS from 2006 to 2015. We described perioperative profiles of NCS cases, including patient, LVAD, surgical case, and anesthetic characteristics, as well as staffing by cardiac/non-cardiac anesthesiologists. Through univariate and multivariable analyses, we studied acute kidney injury (AKI) as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase (LDH) suggestive of LVAD thrombosis, intraoperative bleeding complication, and intraoperative hypotension. We additionally studied major perioperative complications and mortality. Two hundred forty six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative AKI, and 16 (2.6%) had elevated LDH. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with AKI included major surgical procedures (adjusted odds ratio [aOR] 4.4, 95% confidence interval [CI] 1.1–17.3, p = 0.03) and cases prompting invasive arterial line monitoring (aOR 3.6, 95% CI 1.3–10.3, p = 0.02) or preoperative fresh frozen plasma transfusion (aOR 1.7, 95% CI 1.1–2.8, p = 0.02). Intraoperative hypotension and AKI were the most common complications in LVAD patients presenting for NCS; perioperative management remains a challenge.