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Impact of Post-operative Complications after Cardiac Surgery on Long-term Survival
  • +9
  • Siddharth PahwaOrcid,
  • Annalisa Bernabei,
  • Hartzell Schaff,
  • John Stulak,
  • Kevin Greason,
  • Alberto Pochettino,
  • Richard Daly,
  • Joseph Dearani,
  • Gabor Bagameri,
  • Katherine King,
  • Jason Viehman,
  • Juan A. Crestanello
Siddharth Pahwa
Orcid
Mayo Clinic
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Annalisa Bernabei
Mayo Clinic
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Hartzell Schaff
Mayo Clinic
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John Stulak
Mayo Clinc
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Kevin Greason
MAYO CLINIC
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Alberto Pochettino
Mayo Clinic
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Richard Daly
Mayo Clinic
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Joseph Dearani
Mayo Clinic
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Gabor Bagameri
Mayo Clinic
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Katherine King
Mayo Clinic
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Jason Viehman
Mayo Clinic
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Juan A. Crestanello
Mayo Clinic
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Peer review status:IN REVISION

14 May 2020Submitted to Journal of Cardiac Surgery
18 May 2020Assigned to Editor
18 May 2020Submission Checks Completed
20 May 2020Reviewer(s) Assigned
31 May 2020Review(s) Completed, Editorial Evaluation Pending
08 Jun 2020Editorial Decision: Revise Major

Abstract

Background – The impact of post-operative complications on long-term survival is not well characterized. We sought to study the prevalence of post-operative complications after cardiac surgery and their impact on long-term survival. Methods – Operative survivors (n=26,221) who underwent coronary artery bypass grafting (CABG) (n=13054, 49.8%), valve surgery (n=8667, 33.1%) or combined CABG and valve surgery (n=4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for post-operative complications and long-term survival. The associations between post-operative complications and survival were assessed using a Cox-proportional model. Results – Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 post-operative complications were analyzed. Post-operative blood product use was the commonest (n=12397, 47.3%), followed by atrial fibrillation (n=8399, 32.0%), prolonged ventilation (n=2336, 8.9%), renal failure (n=870, 3.3%), re-operation for bleeding (n=859, 3.3%) and pacemaker/ICD insertion (n=795, 3.0%). Stroke (HR 1.55, 95%CI 1.36-1.77), renal failure (HR 1.45, 95% CI 1.33-1.58) anticoagulant-related events (HR 1.26, 95%CI 1.02-1.56) and pneumonia (HR 1.23, 95%CI 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of post-operative complications increased. Conclusions – Post-operative complications after cardiac surgery significantly impact outcomes that extend beyond the post-operative period. The presence, number and type of post-operative complications adversely impact long-term survival. Stroke, renal failure, anticoagulant-related events and pneumonia are particularly associated with poor long-term survival.