Clinical parameters associated with the development of mortality in patients after non-cardial surgical interventions

Abstract

Background.Cardiac arrhythmias remain a clinically significant problem in the conditions of the general surgical department, since they make a significant contribution to the risk of fatal complications. The aim of the study. To study the clinical, instrumental and laboratory characteristics of patients depending on the development or absence of a fatal outcome after non-cardial abdominal surgical interventions, as well as to evaluate the effect of early atrial fibrillation on mortality. Methods. The methodology was carried out according to the type of "case-control" study. 83 lethal "cases" were selected and 143 "controls" were selected. A total of 226 medical histories are included in the analysis. Results.The group with mortality was significantly older than the group without mortality: 75 (64;82) years versus 61 (44;72) years, respectively (p<0.001). Differences in the groups were observed in the severity of concomitant pathology: in the group with mortality, CHF was significantly more pronounced (p<0.001), diabetes mellitus was more common – 34% vs. 10% (p<0.001) and the frequency of COPD was higher – 8.4% vs. 1.4% (p=0.031). However, there were no statistically significant differences in the frequency of myocardial infarction (p=0.121). Statistically significant differences in perioperative parameters included differences in intraoperative infusion of solutions with a volume of more than 3 liters (p=0.003) and in postoperative infusion of solutions with a volume of 1-3 liters and 3-5 liters (p=0.001 and p<0.001). In the group with a fatal outcome, infusion in large volumes significantly prevailed. Also, the group with a fatal outcome was statistically significantly different in the frequency of relaporotomies (p<0.001).; by the frequency of systemic inflammatory reaction syndrome (p<0.001), by the frequency of bleeding (p=0.031), by the frequency of AFP (p<0.001), thromboembolic complications (p<0.001) and the frequency of pneumonia (p<0.001). All of the above events were more often observed in the group of patients with a fatal outcome. Statistically significant independent factors increasing the risk of mortality in our sample were: history of cardiac arrhythmias (OR 3.4 at 95% CI 1.7-6.9), CHF 2-3 FC (OR 6.8 at 95% CI 3.7-12.6), DM (OR 4.9 at 95% CI 2.3-9.6), COPD (OR 6.5 at 95% CI 1.3-32), intraoperative infusion of more than 3 liters (OR 2.9 at 95% CI 1.46-5.7), postoperative infusion of 3-5 liters (OR 2.9 at 95% CI 1.6-5.0), thromboembolic complications (OR 37.9 at 95% CI 8.7-164). Conclusions.Statistically significant independent factors that increase the risk of mortality are: a history of cardiac arrhythmias, heart failure, chronic obstructive pulmonary disease, large infusion of solutions during and after surgery, diabetes mellitus, the development of thromboembolic complications. The development of postoperative atrial fibrillation increases the chances of a fatal outcome by 15 times: the odds ratio was 14.8 with 95% CI from 7.4 to 29.4.