DOI: https://doi.org/10.22141/2224-0586.4.99.2019.173944

Comorbidity as a risk factor of postoperative complications in patients during coronary artery bypass grafting with cardiopulmonary bypass

O.M. Druzhyna, O.A. Loskutov, S.R. Maruniak

Abstract


Background. Carrying out cardiac surgery with cardiopulmonary bypass in aged and geriatric patients may accompanied by a significant risk of postoperative complications. Patients over 65 years of age have an increased risk of morbidity and mortality due to comorbid conditions such as diabetes mellitus, peripheral vascular disease and kidney dysfunction. The purpose was to analyze the main preoperative risk factors in elderly and geriatric patients and to determine their influence on the development of complications in the postoperative period. Materials and methods. According to a preoperative history and examination, comorbidity was found in 102 (first group) of 214 patients involved in the study. Hypertension was observed in 73 (34.1 %) people, cerebrovascular diseases — in 18 (8.4 %), diabetes mellitus — in 27 (12.6 %), chronic obstructive pulmonary disease — in 9 (4.2 %) and chronic kidney disease — in 8 (3.7 %) persons. No signs of comorbidity were found in 112 (52.4 %) patients. All patients were operated under general anesthesia with sevoflurane (1.5–2 minimal alveolar concentrations). Cardiopulmonary bypass was performed on System 1 (Terumo, USA) using Affinity (Medtronic, USA) disposable membrane oxygenators under moderate hypothermia (32 °С). To evaluate hemodynamic changes, we used echocardiography method. Results. The level of troponin in polymorbid patients was significantly higher (by 35.9 %; p = 0.012) compared to patients without comorbidity. It should also be noted that there is a statistically significant correlation between the postoperative troponin level and the comorbidity of patients (r = 0.315). Between the comorbidity of patients and the need for prolonged postoperative inotropic maintenance, a statistically significant correlation relationship was found too (r = 0.411). Among patients with comorbidity, mean creatinine levels were 33.1 and 33.3 % (p = 0.001) higher in men and women, respectively, compared to patients without comorbidity. Correlation coefficients between creatinine levels and comorbidity were 0.452 and 0.486 for males and females, respectively. The duration of mechanical ventilation in the postoperative period was 42.9 % (p = 0.002) significantly longer in patients with comorbid diseases than in persons without comorbidity. At the same time, there was a significant correlation with the comorbidity of patients (r = 0.306). Conclusions. According to the results, patients with comorbid pathology had more severe metabolic disturbances than those without concomitant pathology. In addition, persons with comorbidity had a significantly higher risk of postoperative complications, such as as increased postoperative troponin levels, need for inotropes > 48 hours, acute kidney damage, and longer duration of mechanical ventilation.


Keywords


comorbidity; cardiopulmonary bypass; coronary artery bypass grafting

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