Abstract
BackgroundPost-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool for describing and scoring (0–13) total morbidity burden after cardiac surgery, derived by noting the presence/absence of 13 morbidity domains on days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may suggest targets for intervention to reduce morbidity and healthcare costs. Thus, we explored the association of C-POMS with previously identified predictors of post-operative morbidity.MethodsA systematic literature review of pre-operative risk assessment models for post-operative morbidity was conducted to identify variables associated with post-operative morbidity. The association of those variables with C-POMS was explored in patients drawn from the original C-POMS study (n = 444).ResultsSeventy risk factors were identified, of which 56 were available in the study and 49 were suitable for analysis. Numbers were too few to analyse associations on D15. Thirty-three (67.3%) and 20 (40.8%) variables were associated with C-POMS on at least 1 or 2 days, respectively. Pre-operative albumin concentration, left ventricular ejection fraction and New York Heart Association functional class were associated with C-POMS on all days. Of the 16 independent risk factors, pre-operative albumin and haemoglobin concentrations and weight are potentially modifiable.ConclusionsDifferent risk factors are associated with total morbidity burden on different post-operative days. Pre-operative albumin and haemoglobin concentrations and weight were independently predictive of post-operative total morbidity burden suggesting therapeutic interventions aimed at these might reduce both post-operative morbidity risk and health-care costs in patients undergoing cardiac surgery.
Highlights
Post-operative morbidity affects up to 36% of cardiac surgical patients
We have previously reported that every unit increase in Cardiac Post-Operative Morbidity Score (C-POMS) is associated with a 1.7, 2.2 and 4.5-day increase in subsequent length of stay (LOS) on days 3 (D3), 5 (D5) and 8 (D8) (Sanders et al 2012), which has significant associated health-care costs, organisational and resource implications
Six participants declined for their data to be used outside the development of C-POMS
Summary
Post-operative morbidity affects up to 36% of cardiac surgical patients. few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. While cardiac operative mortality has fallen (currently 2.1% in the USA (Society of Thoracic Surgeons) and 1.5% in the UK (Bridgewater et al 2008)), post-operative morbidity remains common affecting between 4.3% (Fortescue et al 2001) and 36% (Magovern et al 1996) of cardiac patients and significantly prolonging length of stay (LOS) (Dupuis et al 2001). Such morbidity has substantial impact on healthcare resources, with the average in-hospital incremental cost of experiencing any complication at. The Society of Thoracic Surgeons national database contains 49 variables related to post-operative events, a composite metric aimed at defining post-operative
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