1. Trends in the Utilization of Multiorgan Support Among Adults Undergoing High-risk Cardiac Surgery in the United States.
- Author
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Cobert J, Frere Z, Wongsripuemtet P, Ohnuma T, Krishnamoorthy V, Fuller M, Chapman AC, Yaport M, Ghadimi K, Bartz R, and Raghunathan K
- Subjects
- Humans, Male, Retrospective Studies, Female, United States epidemiology, Middle Aged, Aged, Adult, Postoperative Complications epidemiology, Hospital Mortality trends, Risk Factors, Cohort Studies, Cardiac Surgical Procedures trends, Cardiac Surgical Procedures mortality, Multiple Organ Failure epidemiology, Multiple Organ Failure mortality
- Abstract
Objectives: To examine trends in the prevalence of multiorgan dysfunction (MODS), utilization of multi-organ support (MOS), and mortality among patients undergoing cardiac surgery with MODS who received MOS in the United States., Design: Retrospective cohort study., Setting: 183 hospitals in the Premier Healthcare Database., Participants: Adults ≥18 years old undergoing high-risk elective or non-elective cardiac surgery., Interventions: none., Measurements and Main Results: The exposure was time (consecutive calendar quarters) January 2008 and June 2018. We analyzed hospital data using day-stamped hospital billing codes and diagnosis and procedure codes to assess MODS prevalence, MOS utilization, and mortality. Among 129,102 elective and 136,190 non-elective high-risk cardiac surgical cases across 183 hospitals, 10,001 (7.7%) and 21,556 (15.8%) of patients developed MODS, respectively. Among patients who experienced MODS, 2,181 (22%) of elective and 5,425 (25%) of non-elective cardiac surgical cases utilized MOS. From 2008-2018, MODS increased in both high-risk elective and non-elective cardiac surgical cases. Similarly, MOS increased in both high-risk elective and non-elective cardiac surgical cases. As a component of MOS, mechanical circulatory support (MCS) increased over time. Over the study period, risk-adjusted mortality, in patients who developed MODS receiving MOS, increased in high-risk non-elective cardiac surgery and decreased in high-risk elective cardiac surgery, despite increasing MODS prevalence and MOS utilization (p<0.001)., Conclusions: Among patients undergoing high-risk cardiac surgery in the United States, MODS prevalence and MOS utilization (including MCS) increased over time. Risk-adjusted mortality trends differed in elective and non-elective cardiac surgery. Further research is necessary to optimize outcomes among patients undergoing high-risk cardiac surgery., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JC reports consulting fees from Teleflex, but there are no other conflicts of interest to report., (Published by Elsevier Inc.)
- Published
- 2024
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