Which factors predict major pulmonary complications following cardiac surgery?

Among patients undergoing cardiac surgery, central sleep apnoea, heart failure, and history of transient ischaemic attack or stroke are a red flag for postoperative major pulmonary complications (MPCs), according to a study.

Researchers conducted a subanalysis of the ongoing prospective observational study CONSIDER AF* in a bid to determine preoperative risk factors in 250 patients who underwent cardiac surgery. Postoperative MPCs (including respiratory failure, acute respiratory distress syndrome, pneumonia, or pulmonary embolism) were recorded within the first 7 postoperative days. Sleep-disordered breathing (SDB), its presence and type, was evaluated the night prior to surgery via a portable monitoring device.

Postoperative MPCs occurred with significantly greater frequency in patients with versus without SDB (24 percent vs 7 percent; p<0.001).

On multivariable logistic regression analysis, factors significantly associated with postoperative MPCs were central sleep apnoea (odds ratio [OR], 4.68, 95 percent confidence interval [CI], 1.78–12.26; p=0.002), heart failure (OR, 2.65, 95 percent CI, 1.11–6.31; p=0.028), and a history of transient ischaemic attack or stroke (OR, 2.73, 95 percent CI, 1.07–6.94; p=0.035).

Compared with those who did not experience complications after the surgery, patients with MPCs had a significantly longer hospital stay (median days, 9 vs 19; p<0.001).

The present data contribute to the identification of patients who are at high risk of postoperative MPCs.

*Impact of Sleep-disordered breathing on Atrial Fibrillation and Perioperative complications in Patients undergoing Coronary Artery Bypass grafting Surgery