Intraoperative myocardial acidosis as a risk for hospital readmission after cardiac surgery

Am J Surg. 2009 Sep;198(3):373-80. doi: 10.1016/j.amjsurg.2009.01.013.

Abstract

Background: This study elucidates the relationship between intraoperative myocardial acidosis/ischemia and the risk of unplanned hospital readmissions within 30 days and 6 months after cardiac surgery.

Methods: Myocardial tissue pH (corrected to 37 degrees C: pH(37C)) was monitored in 221 patients during cardiac surgery. Regional myocardial acidosis was defined in terms of specific pH thresholds.

Results: Fourteen percent and 27% of the patients were readmitted within 30 days and 6 months postoperatively, respectively. The mean number of readmissions was 1.67 +/- 1.24; pH(37C) <6.85 at the end of cardiopulmonary bypass (CPB) was identified as the threshold most significantly associated with readmission. This threshold was associated with a 6-fold increased risk of readmission within 30 days and a 5-fold increased risk within 6 months.

Conclusions: Persistent regional myocardial acidosis after weaning from CPB independently determines unplanned readmission rates up to 6 months postoperatively. This study underscores the importance of avoiding myocardial tissue acidosis during cardiac surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis / mortality
  • Acidosis / prevention & control*
  • Aged
  • Cardiac Surgical Procedures* / mortality
  • Cardiopulmonary Bypass
  • Chi-Square Distribution
  • Female
  • Humans
  • Hydrogen-Ion Concentration
  • Intraoperative Complications / mortality
  • Intraoperative Complications / prevention & control*
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Ischemia / mortality
  • Myocardial Ischemia / prevention & control*
  • Patient Readmission / statistics & numerical data*
  • ROC Curve
  • Risk Factors