Pulmonary Hypertension and the Risk of 30-Day Postoperative Pulmonary Complications After Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score-Weighted Cohort Analysis

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Apr 13

PMID 38610760

Authors

Yoshio Tatsuoka

Zyad J Carr

Sachidhanand Jayakumar

Hung-Mo Lin

Zili He

Adham Farroukh

Paul Heerdt

Affiliations

Soon will be listed here.

Abstract

: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPCs). : A single-center propensity score overlap weighting (OW) retrospective cohort study was conducted on 164 patients with a mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia and a control cohort (N = 1981). The primary outcome was PPCs, and the secondary outcomes were PPC sub-composites, namely respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. : PPCs were higher in the PH cohort (29.9% vs. 11.2%, < 0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, < 0.001) and PNA (11.2% vs. 5.7%, = 0.01) were observed. After OW, PH was still associated with greater PPCs (RR 1.66, 95% CI (1.05-2.71), = 0.036) and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPCs between pre- and post-capillary PH patients. : After covariate balancing, PH was associated with a higher risk for PPCs and prolonged LOS. This elevated PPC risk should be considered during preoperative risk assessment.

References

Protopapa K, Simpson J, Smith N, Moonesinghe S . Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg. 2014; 101(13):1774-83. PMC: 4240514. DOI: 10.1002/bjs.9638. View

Minai O, Venkateshiah S, Arroliga A . Surgical intervention in patients with moderate to severe pulmonary arterial hypertension. Conn Med. 2006; 70(4):239-43. View

Chung L, Liu J, Parsons L, Hassoun P, McGoon M, Badesch D . Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest. 2010; 138(6):1383-94. PMC: 3621419. DOI: 10.1378/chest.10-0260. View

Aasen D, Bronsert M, Rozeboom P, Colborn K, Henderson W, Lambert-Kerzner A . Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database. Surgery. 2020; 169(2):325-332. DOI: 10.1016/j.surg.2020.08.009. View

Rosenkranz S, Pausch C, Coghlan J, Huscher D, Pittrow D, Grunig E . Risk stratification and response to therapy in patients with pulmonary arterial hypertension and comorbidities: A COMPERA analysis. J Heart Lung Transplant. 2022; 42(1):102-114. DOI: 10.1016/j.healun.2022.10.003. View

Ma G, Liao W, Qiu J, Su Q, Fang Y, Gu B . N-terminal prohormone B-type natriuretic peptide and weaning outcome in postoperative patients with pulmonary complications. J Int Med Res. 2013; 41(5):1612-21. DOI: 10.1177/0300060513490085. View

Murad K, Kitzman D . Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev. 2011; 17(4-5):581-8. PMC: 3804644. DOI: 10.1007/s10741-011-9258-y. View

Yap L, Ashrafian H, Mukerjee D, Coghlan J, Timms P . The natriuretic peptides and their role in disorders of right heart dysfunction and pulmonary hypertension. Clin Biochem. 2004; 37(10):847-56. DOI: 10.1016/j.clinbiochem.2004.06.002. View

Koirala U, Thapa P, Joshi M, Singh D, Sharma S . Systemic Inflammatory Response Syndrome following Gastrointestinal Surgery. JNMA J Nepal Med Assoc. 2017; 56(206):221-225. View

10.

Gelzinis T . Pulmonary Hypertension in 2021: Part I-Definition, Classification, Pathophysiology, and Presentation. J Cardiothorac Vasc Anesth. 2021; 36(6):1552-1564. DOI: 10.1053/j.jvca.2021.06.036. View

11.

Price L, Martinez G, Brame A, Pickworth T, Samaranayake C, Alexander D . Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth. 2021; 126(4):774-790. DOI: 10.1016/j.bja.2021.01.005. View

12.

Humbert M, Kovacs G, Hoeper M, Badagliacca R, Berger R, Brida M . 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022; 43(38):3618-3731. DOI: 10.1093/eurheartj/ehac237. View

13.

Hansen L, Burks M, Kingman M, Stewart T . Volume Management in Pulmonary Arterial Hypertension Patients: An Expert Pulmonary Hypertension Clinician Perspective. Pulm Ther. 2020; 4(1):13-27. PMC: 6966996. DOI: 10.1007/s41030-018-0052-z. View

14.

Price L, Montani D, Jais X, Dick J, Simonneau G, Sitbon O . Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension. Eur Respir J. 2009; 35(6):1294-302. DOI: 10.1183/09031936.00113009. View

15.

Baptista de Barros Ribeiro Dourado L, Santos M, Moreira-Goncalves D . Nets, pulmonary arterial hypertension, and thrombo-inflammation. J Mol Med (Berl). 2022; 100(5):713-722. DOI: 10.1007/s00109-022-02197-0. View

16.

Braunstein J, Anderson G, Gerstenblith G, Weller W, Niefeld M, Herbert R . Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003; 42(7):1226-33. DOI: 10.1016/s0735-1097(03)00947-1. View

17.

Asllanaj B, Benge E, Bae J, McWhorter Y . Fluid management in septic patients with pulmonary hypertension, review of the literature. Front Cardiovasc Med. 2023; 10:1096871. PMC: 10017881. DOI: 10.3389/fcvm.2023.1096871. View

18.

Lawrence V, Dhanda R, Hilsenbeck S, Page C . Risk of pulmonary complications after elective abdominal surgery. Chest. 1996; 110(3):744-50. DOI: 10.1378/chest.110.3.744. View

19.

Quarck R, Nawrot T, Meyns B, Delcroix M . C-reactive protein: a new predictor of adverse outcome in pulmonary arterial hypertension. J Am Coll Cardiol. 2009; 53(14):1211-8. DOI: 10.1016/j.jacc.2008.12.038. View

20.

Messmer A, Zingg C, Muller M, Gerber J, Schefold J, Pfortmueller C . Fluid Overload and Mortality in Adult Critical Care Patients-A Systematic Review and Meta-Analysis of Observational Studies. Crit Care Med. 2020; 48(12):1862-1870. DOI: 10.1097/CCM.0000000000004617. View