Determinants of Mortality in Adult Patients after Open Heart Surgery in Duhok City-kurdistan Region

Abstract

Introduction: Despite improvements in the techniques and perioperative management in modern cardiac surgeries avoidable deaths still occur. In this regard, we aimed to determine the main causes of death following adult heart surgery and identify the most associated factors. Patients and Methods: In this case-control study, the medical records of the patients who died (n=50) or survived open heart surgery (n=80) were used at Azadi Heart Center in Duhok city in the period between January 1, 2016, and December 31, 2020. Results: The most common causes of mortality in cardiac patients were cardiogenic shock (26%) cardiac arrest (24%), renal failure (18%), septic shock (12%), CVA (6%), and cardiac events. The most associated factors were advanced age (P<0.000), occupation (P=0.007), hypertension (P=0.013), hyperlipidemia (P=0.013), heart failure (P=0.020), preoperative low ejection fraction (P=0.002), preoperative elevated renal function (P=0.015), type and timing of surgery (P=0.010, 0.023) for each, type of valve used (P=0.023), type of CABG (P=0.009), prolonged duration of bypass and aortic cross-clamp time (P<0.000, 0.000) for each, intraoperative event (P<0.000), duration of intubation and need for re-intubation (P<0.0001,0.0001) for each, need for inotropic agents (P<0.000), post-operative elevated renal function and WBC (P<0.000,0.000) respectively, need for re-admission (P<0.000), postoperative complications(cardiac P=0.031, chest P=0.039, wound P=0.031, neurological P=0.007, renal P<0.000, and arrhythmia P<0.000), and prolonged both ICU and overall hospital stay (P<0.000,0.000) for each. Conclusion: This study showed that several general, pre-operative, intra-operative, and post-operative factors are associated with the mortality of cardiac patients