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

Volumn 197, Issue 2, 2009, Pages 203-210

  Healey, Christine M ^a,b   Kumbhani, Dharam J ^a   Healey, Nancy A ^a   Crittenden, Michael D ^a,c,d   Gibson, Stephen F ^a   Khuri, Shukri F ^a,c,d  

^a VA BOSTON HEALTHCARE SYSTEM   (United States)

^b ALBANY MEDICAL COLLEGE   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

^d BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

Aortic cross clamp; Cost; Ischemia; Outcomes; Reperfusion

Indexed keywords

ACIDOSIS; AGED; AORTA CLAMPING; ARTICLE; BODY SURFACE; CARDIOPULMONARY BYPASS; DIABETES MELLITUS; FEMALE; HEALTH CARE COST; HEART MUSCLE REPERFUSION; HUMAN; INTRAOPERATIVE PERIOD; MAJOR CLINICAL STUDY; MALE; MORBIDITY; MYOCARDIAL ACIDOSIS; OPERATION DURATION; PERIOPERATIVE PERIOD; PH MEASUREMENT; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; SURGICAL MORTALITY; TEMPERATURE;

ACIDOSIS; AGED; AORTA; CARDIOMYOPATHIES; CARDIOPULMONARY BYPASS; CONSTRICTION; FEMALE; HUMANS; HYDROGEN-ION CONCENTRATION; INTRAOPERATIVE CARE; MALE; MIDDLE AGED; MYOCARDIUM; TIME FACTORS;

EID: 58649103777     PISSN: 00029610     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.amjsurg.2008.01.023     Document Type: Article

References (40)

1. Cernaianu A.C., Vassilidze T.V., Flum D.R., et al. Predictors of stroke after cardiac surgery. J Card Surg 10 (1995) 334-339
2. Byhahn C., Strouhal U., Martens S., et al. Incidence of gastrointestinal complications in cardiopulmonary bypass patients. World J Surg 25 (2001) 1140-1144
3. Mierdl S., Meininger D., Dogan S., et al. Abdominal complications after cardiac surgery. Ann Acad Med Singapore 30 (2001) 245-249
4. Gatti G., Cardu G., Lusa A.M., et al. Predictors of postoperative complications in high-risk octogenarians undergoing cardiac surgery. Ann Thorac Surg 74 (2002) 671-677
5. Smith P.K., Carrier M., Chen J.C., et al. Effect of pexelizumab in coronary artery bypass graft surgery with extended aortic cross-clamp time. Ann Thorac Surg 82 (2006) 781-789
6. Zou J., Yu A., Li W., et al. Analysis of complications after cardiac valve replacement: report of 702 patients. Zhonhhua Wai Ke Za Zhi 40 (2002) 354-356
7. Louagie Y., Buche M., Jamart J., et al. 1990-1993: evaluation of perioperative variables. Thorac Cardiovasc Surg 43 (1995) 134-141
8. Deiwick M., Tandler R., Mollhoff T., et al. Heart surgery in patients aged eighty years and above: determinants of morbidity and mortality. Thorac Cardiovasc Surg 45 (1997) 119-126
9. Rady M.Y., Ryan T., and Starr N.J. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med 26 (1998) 225-235
10. Flameng W., Herijgers P., Szecsi J., et al. Determinants of early and late results of combined valve operations and coronary artery bypass grafting. Ann Thorac Surg 61 (1996) 621-628
11. Herlitz J., Brandrup-Wognsen G., Caidahl K., et al. Mortality and morbidity among patients who undergo combined valve and coronary artery bypass surgery: early and late results. Eur J Cardiothorac Surg 12 (1997) 836-846
12. Dimick J.B., Chen S.L., Taheri P.A., et al. Hospital costs associated with surgical complications: a report from the private sector NSQIP program. J Am Coll Surg 199 (2004) 531-537
13. Kalish R.L., Daley J., Duncan C.C., et al. Costs of potential complications of care for major surgery patients. Am J Med Qual 10 (1995) 48-54
14. Naglie G., Tansey C., Krahn M.D., et al. Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. CMAJ 160 (1999) 805-811
15. Bohmer R.M.J., Newell J., and Torchiana D.F. The effect of decreasing length of stay on hospital discharge destination and readmission after coronary bypass operation. Surgery 132 (2002) 10-15
16. Davenport D.L., Henderson W.G., Khuri S.F., et al. Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) Database. Ann Surg 424 (2006) 463-471
17. Almassi G.H., Schowalter T., Nicolosi A.C., et al. Atrial fibrillation after cardiac surgery; a major morbid event?. Ann Surg 226 (1997) 501-513
18. Krueger H., Goncalves J.L., Caruth F.M., et al. Coronary artery bypass grafting: how much does it cost?. CMAJ 146 (1992) 163-168
19. MaWhinney S., Brown E.R., Malcolm J., et al. Identification of risk factors for increased cost, charges, and length of stay for cardiac patients. Ann Thorac Surg 70 (2000) 702-710
20. Committee on Enhancing Federal Healthcare Quality Programs. IOM Report. Leadership by Example: Coordinating Government Roles in Improving Healthcare Quality (2003), National Academic Press, Washington
21. Barnett P.G., and Rodgers J.H. Use of the decision support system for VA cost-effectiveness research. Med Care 37 Suppl Va (1999) AS63-AS70
22. Barnett P.G. Determination of VA health care costs. Med Care Res Rev 60 (2003) 124S-141S
23. Lange R., Kloner R.A., Zeiler M., et al. Time course of ischemic alteration during normothermic and hypothermic arrest and its reflection by online monitoring of tissue pH. J Thorac Cardiovasc Surg 86 (1983) 418-434
24. 2 and its relationship to myocardial pH after regional occlusion in the dog. Circ Res 56 (1985) 537-547
25. Khuri S.F., Josa M., Marston W., et al. First report of intramyocardial pH in man: II. Assessment of adequacy of myocardial preservation. J Thorac Cardiovasc Surg 86 (1983) 667-678
26. Kumbhani D.J., Healey N.A., Biswas K.S., et al. Adverse 30-day outcomes after cardiac surgery: predictive role of intraoperative myocardial acidosis. Ann Thorac Surg 80 (2005) 1751-1757
27. Khuri S.F., Healey N.A., Hossain M., et al. Intra-operative regional myocardial acidosis and reduction in long-term survival after cardiac surgery. J Thorac Cardiovasc Surg 129 (2005) 372-381
28. Khuri S.F. Myocardial pH monitoring system. http://www.terumo-cvs.com/for-clinicians/khuriph Accessed: May 2, 2006
29. Kumbhani D.J., Healey N.A., Birjiniuk V., et al. Determinants of regional myocardial acidosis during cardiac surgery. Surgery 136 (2004) 190-198
30. Khuri S.F., Healey N.A., Zolkewitz M., et al. Determinants of myocardial tissue acidosis during prolonged aortic clamping. Circulation 94 Suppl (1996) I-170
31. Kumbhani D.J., Healey N.A., Birjiniuk V., et al. Intraoperative regional myocardial acidosis predicts the need for inotropic support in cardiac surgery. Am J Surg 188 (2004) 474-480
32. Kumbhani D.J., Healey N.A., Thatte H.S., et al. Readmission after cardiac surgery: the role of intraoperative myocardial acidosis. J Am Coll Surg 199 (2004) S71
33. Kumbhani D.J., Healey N.A., Thatte H.S., et al. Patients with diabetes mellitus undergoing cardiac surgery are at greater risk for developing intraoperative myocardial acidosis. J Thoracic Cardiovasc Surg 133 (2007) 1566-1572
34. Khabbaz K.R., Zankoul F., and Warner K.G. Intraoperative metabolic monitoring of the heart: I.1. Online measurement of myocardial tissue pH. Ann Thorac Surg 72 (2001) S2227-S2234
35. Khuri S.F., Daley J., Henderson W.G., et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 180 (1995) 519-531
36. Khuri S.F., Daly J., Henderson W.G., et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Rick Study. J Am Coll Surg 185 (1997) 315-327
37. Daly J., Khuri S.F., Henderson W.G., et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Rick Study. J Am Coll Surg 185 (1997) 328-340
38. Swindle R., Likas C.V., Meyer D.A., et al. Cost analysis in the Department of Veterans Affairs: consensus and future directions. Med Care 37 Suppl Va (1999) AS3-AS8
39. Hosmer D.W. Model building. In: Hosmer D.W., and Lemeshow S. (Eds). Applied Logistic Regression. 2nd ed. (2000), Wiley, New York 91-114
40. Lemeshow S., and Hosmer Jr. D.W. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 115 (1982) 92-106