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Predictors and Early and Late Outcomes of Respiratory Failure in Contemporary Cardiac Surgery^*

^* From the Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY.

Correspondence to: Farzan Filsoufi, MD, Associate Professor, Associate Chief Cardiac Surgery, Mount Sinai School of Medicine, 1190 Fifth Ave, New York, NY 10029-1028; e-mail: farzan.filsoufi{at}mountsinai.org

Abstract

Background: Respiratory failure (RF) is a serious complication following heart surgery. The profile of patients referred for cardiac surgery has changed during the last decade, making prior investigations of RF after cardiac surgery less relevant to the current population. This study was designed to analyze the incidence, predictors of RF, and early and late outcomes following this complication in a large contemporary cardiac surgery population.

Methods: We retrospectively analyzed prospectively collected data from the New York State Department of Health database including 5,798 patients undergoing cardiac surgery between January 1998 and December 2005. Patients with RF (intubation time 72 h) were compared to patients without RF.

Results: The incidence of RF was 9.1% (n = 529). The highest incidence of RF was observed following combined valve/coronary artery bypass graft (14.8%) and aortic procedures (13.5%). Multivariate analysis revealed preoperative and operative predictors of RF such as renal failure (odds ratio [OR], 2.3), aortic procedures (OR, 2.6), hemodynamic instability (OR, 3.2), and intraaortic balloon pump (OR, 2.6). The mortality rate following RF was 15.5% (n = 82), compared to 2.4% (n = 126) in the no-RF group (p < 0.001). Kaplan-Meier survival curves showed significantly poorer survival among RF patients (p < 0.001) compared to the no-RF group.

Conclusion: RF remains a serious and common complication following cardiac surgery, particularly in patients undergoing complex procedures. RF is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival. Future research efforts should focus on a more precise identification of patients at risk and the development of new treatment modalities that would potentially prevent the occurrence of this complication.

Key Words: coronary artery bypass graft surgery • mortality • New York State Department of Health database • respiratory failure • survival