Factors Predicting Severity of Postoperative Pulmonary Complications within the First 7 Days among Open-Heart Surgery Patients
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Abstract
Purpose: To examine the predictors of severity of pulmonary complications within seven days after open-heart surgery, including hemoglobin levels, obstructive sleep apnea, atrial fibrillation, inotropic drug use, duration of intubation, and readiness for ventilator weaning.
Design: A cross-sectional study.
Methods: The participants were 148 open-heart surgery patients aged ≥ 18 years who were admitted to a university hospital in Bangkok, Thailand. Data were collected using the Thai version of a cognitive function assessment, a questionnaire and recording form on personal information, health status, illness, and treatment, scores for the use of inotropic and vasoactive drugs, and an assessment tool for the severity of complications. Multiple linear regression with the enter method was used to examine the predictors of the severity of pulmonary complications.
Main findings: The average age of the participants was 64.2 (SD = 10.99) years. The average severity of postoperative pulmonary complications was 17.20 (SD = 10.65) points. Significant predictors of the severity of postoperative pulmonary complications were obstructive sleep apnea (B = 9.60; 95%CI [.12, 19.08], p = .04) and duration of intubation (B = .12; 95%CI [.06, .17], p < .001). Hemoglobin level, atrial fibrillation, readiness for ventilator weaning, and the amount of inotropic drugs use were not significant predictors.
Conclusion and recommendations: Healthcare providers should assess risk factors of severity of postoperative pulmonary complications, particularly those with a history of obstructive sleep apnea and prolonged intubation. In addition, development guidelines for assessing the severity of postoperative pulmonary complications are crucial for effectively preventing these complications.
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References
Ismail A, Semien G, Sharma S, Collier SA, Miskolczi SY. Cardiopulmonary bypass. Treasure Island, FL: StatPearls Publishing; 2024. 42 p.
Crawford TC, Magruder JT, Grimm JC, Suarez-Pierre A, Sciortino CM, Mandal K, et al. Complications after cardiac operations: all are not created equal. Ann Thorac Surg. 2017;103(1):32-40. doi: 10.1016/j.athoracsur.2016.10.022.
Pahwa S, Bernabei A, Schaff H, Stulak J, Greason K, Pochettino A, et al. Impact of postoperative complications after cardiac surgery on long-term survival. J Card Surg. 2021;36(6):2045-52. doi: 10.1111/jocs.15471.
Ariyaratnam P, Ananthasayanam A, Moore J, Vijayan A, Hong V, Loubani M. Prediction of postoperative outcomes and long-term survival in cardiac surgical patients using the intensive care national audit & research centre sore. J Cardiothorac Vasc Anesth. 2019;33(11):3022-7. doi: 10.1053/j.jvca.2019.05.034.
Chandler D, Mosieri C, Kallurkar A, Pham AD, Okada LK, Kaye RJ, et al. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol. 2020;34(2):153-66. doi: 10.1016/j.bpa.2020.04.011.
Setak-Berenjestanaki M, Bagheri-Nesami M, Gholipour Baradari A, Mousavinasab SN, Ghaffari R, Darbeheshti M. The prophylactic effect of different levels of positive end expiratory pressure on the incidence rate of atelectasis after cardiac surgery: a randomized controlled trial. Med J Islam Repub Iran. 2018;32:20. doi: 10.14196/mjiri.32.20.
Doran DI, Sidani S, Keatings M, Doidge D. An empirical test of the nursing role effectiveness model. J Adv Nurs. 2002;38(1):29-39. doi: 10.1046/j.1365-2648.2002.02143.x.
Fan G, Fu S, Zheng M, Xu W, Ma G, Zhang F, et al. Association of preoperative frailty with pulmonary complications after cardiac surgery in elderly individuals: a prospective cohort study. Aging Clin Exp Res. 2023;35(11):2453-62. doi: 10.1007/s40520-023-02527-3.
Cavayas YA, Eljaiek R, Rodrigue É, Lamarche Y, Girard M, Wang HT, et al. Preoperative diaphragm function is associated with postoperative pulmonary complications after cardiac surgery. Crit Care Med. 2019;47(12):e966-e74. doi: 10.1097/CCM.0000000000004027.
Baris O, Onyilmaz TA, Kaya H. Frequency and predictors of pneumonia after isolated Coronary Artery Bypass Grafting (CABG): a single-center study. Diagnostics (Basel). 2025;15(2):195. doi: 10.3390/diagnostics15020195.
Padmanabhan H, Aktuerk D, Brookes MJ, Nevill AM, Ng A, Cotton J, et al. Anemia in cardiac surgery: next target for mortality and morbidity improvement? Asian Cardiovasc Thorac Ann. 2016;24(1):12-7. doi: 10.1177/0218492315618032.
Kowalewski M, Raffa GM, Pasierski M, Kołodziejczak M, Litwinowicz R, Wańha W, et al. Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock. Sci Rep. 2023;13(1):21818. doi: 10.1038/s41598-023-47642-3.
Ng KT, Lee ZX, Ang E, Teoh WY, Wang CY. Association of obstructive sleep apnea and postoperative cardiac complications: a systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2020;62:109731. doi: 10.1016/j.jclinane.2020.109731.
Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung. 2020;198(6):889-96. doi: 10.1007/s00408-020-00405-7.
Wang D, Huang X, Wang H, Le S, Yang H, Wang F, et al. Risk factors for postoperative pneumonia after cardiac surgery: a prediction model. J Thorac Dis. 2021;13(4):2351-62. doi: 10.21037/jtd-20-3586.
Ghanbari A, Mohammad Ebrahimzadeh A, Paryad E, Atrkar Roshan Z, Kazem Mohammadi M, Mokhtari Lakeh N. Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients. Heart Lung. 2020;49(3):296-300. doi: 10.1016/j.hrtlng.2020.01.003.
Liu Y, An Z, Chen J, Liu Y, Tang Y, Han Q, et al. Risk factors for noninvasive ventilation failure in patients with post-extubation acute respiratory failure after cardiac surgery. J Thorac Dis. 2018;10(6):3319-28. doi: 10.21037/jtd.2018.05.96.
Colak MC, Colak C, Erdil N, Sandal S. Potential risk factors for early large pleural effusion after coronary artery bypass grafting surgery. Biomed Res. 2017;28(2):625-9.
Aksoy R, Karakoc AZ, Cevirme D, Elibol A, Yigit F, Yilmaz Ü, et al. Predictive factors of prolonged ventilation following cardiac surgery with cardiopulmonary bypass. Braz J Cardiovasc Surg. 2021;36(6):780-7. doi: 10.21470/1678-9741-2020-0164.
Thanavaro J, Taylor J, Vitt L, Guignon MS, Thanavaro S. Predictors and outcomes of postoperative respiratory failure after cardiac surgery. J Eval Clin Pract. 2020;26(5):1490-7. doi: 10.1111/jep.13334.
Fischer MO, Brotons F, Briant AR, Suehiro K, Gozdzik W, Sponholz C, et al. Postoperative pulmonary complications after cardiac surgery: the VENICE international cohort study. J Cardiothorac Vasc Anesth. 2022;36(8):2344-51. doi: 10.1053/j.jvca.2021.12.024.
Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of pulmonary complications after cardiopulmonary bypass. Pak J Med Sci. 2017;33(4):993-6. doi: 10.12669/pjms.334.12846.
Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317-34. doi: 10.1093/bja/aex002.
Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 10th ed. Philadelphia, PA: Wolters Kluwer Health; 2017. 1164 p.
Yamazaki Y, Oba K, Matsui Y, Morimoto Y. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth. 2018;32(2):167-73. doi: 10.1007/s00540-018-2447-2.
Koponen T, Karttunen J, Musialowicz T, Pietiläinen L, Uusaro A, Lahtinen P. Vasoactive inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019;122(4):428-36. doi: 10.1016/j.bja.2018.12.019.
Mete EMT, Bastopcu M, Acarel M. 24th hour vasoactive inotrope score is associated with poor outcome in adult cardiac surgery. Rev Assoc Med Bras. 2023;69(5):e20221433. doi: 10.1590/1806-9282.20221433.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien P-A. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1-7. doi: 10.1097/SLA.0b013e318296c732.
Khanna AK, Kelava M, Ahuja S, Makarova N, Liang C, Tanner D, et al. A nomogram to predict postoperative pulmonary complications after cardiothoracic surgery. J Thorac Cardiovasc Surg. 2023;165(6):2134-46. doi: 10.1016/j.jtcvs.2021.08.034.
Wolf S, Wolf C, Cattermole TC, Rando HJ, DeNino WF, Iribarne A, et al. Cardiac surgery outcomes: a case for increased screening and treatment of obstructive sleep apnea. Ann Thorac Surg. 2022;113(4):1159-64. doi: 10.1016/j.athoracsur.2021.04.046.
Javaherforooshzadeh F, Amjadzadeh M, Haybar H, Sharafkhaneh A. Impact of obstructive sleep apnea diagnosed using the stop bang questionnaire scale on postoperative complications following major cardiac surgery: a prospective observational cohort study. Cureus. 2022;14(6):e26102. doi: 10.7759/cureus.26102.
Mason M, Hernández Sánchez J, Vuylsteke A, Smith I. Usefulness of the STOP Bang Questionnaire in a cardiac surgical population. J Cardiothorac Vasc Anesth. 2018;32(6):2694-9. doi: 10.1053/j.jvca.2018.04.049.
Kumalasari RI, Kosasih CE, Priambodo AP. A scoping review of factors associated with delayed extubation in post cardiac surgery patients. Vasc Health Risk Manag. 2025;21:1-15. doi: 10.2147/VHRM.S479352.
