Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery

Juan A. Crestanello, Gary Phillips, Michael S. Firstenberg, Chittoor Sai-Sudhakar, John Sirak, Robert Higgins, William T. Abraham

Research output: Contribution to journalArticle

Abstract

Background: The association between postoperative hyponatremia (Na <135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. Study Design: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. Results: Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p <0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p <0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m2, p = 0.01), higher EuroSCORE (median, 15% vs 6%, p <0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p <0.001), and peripheral vascular disease (16% vs 12%, p <0.001). Hyponatremia increased overall (24% vs 18.2%, p <0.001) and late mortality (18.6% vs 13.9%, p <0.001) and length of stay (LOS; 11 vs 7 days, p <0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p <0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p <0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p <0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p <0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001). Conclusions: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
Volume216
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

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Hyponatremia
Hospital Mortality
Thoracic Surgery
Length of Stay
Odds Ratio
Mortality
Peripheral Vascular Diseases
Postoperative Care
Glomerular Filtration Rate
Chronic Obstructive Pulmonary Disease
Pulmonary Artery
Heart Ventricles
Renal Insufficiency
Dialysis
Logistic Models
Regression Analysis
Pressure
Lung

ASJC Scopus subject areas

  • Surgery

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Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery. / Crestanello, Juan A.; Phillips, Gary; Firstenberg, Michael S.; Sai-Sudhakar, Chittoor; Sirak, John; Higgins, Robert; Abraham, William T.

In: Journal of the American College of Surgeons, Vol. 216, No. 6, 06.2013.

Research output: Contribution to journalArticle

Crestanello, Juan A. ; Phillips, Gary ; Firstenberg, Michael S. ; Sai-Sudhakar, Chittoor ; Sirak, John ; Higgins, Robert ; Abraham, William T. / Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 6.
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abstract = "Background: The association between postoperative hyponatremia (Na <135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. Study Design: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. Results: Postoperative hyponatremia was present in 59{\%}. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44{\%} ± 16{\%} vs 48{\%} ± 13{\%}, p <0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p <0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m2, p = 0.01), higher EuroSCORE (median, 15{\%} vs 6{\%}, p <0.001), higher New York Heart Association class IV (31{\%} vs 26{\%}, p = 0.002), prevalence of COPD (23{\%} vs 14{\%}, p <0.001), and peripheral vascular disease (16{\%} vs 12{\%}, p <0.001). Hyponatremia increased overall (24{\%} vs 18.2{\%}, p <0.001) and late mortality (18.6{\%} vs 13.9{\%}, p <0.001) and length of stay (LOS; 11 vs 7 days, p <0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95{\%} CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95{\%} CI 1.22-1.49, p <0.001), infectious (odds ratio [OR] 2.32, 95{\%} CI 1.48-3.62, p <0.001), pulmonary (OR 1.82, 95{\%} CI 1.49-2.21, p <0.001), and renal failure complications (OR 2.46, 95{\%} CI 1.58-3.81, p <0.001) and need for dialysis (OR 3.66, 95{\%} CI 1.72-7.79, p = 0.001). Conclusions: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.",
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T1 - Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery

AU - Crestanello, Juan A.

AU - Phillips, Gary

AU - Firstenberg, Michael S.

AU - Sai-Sudhakar, Chittoor

AU - Sirak, John

AU - Higgins, Robert

AU - Abraham, William T.

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N2 - Background: The association between postoperative hyponatremia (Na <135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. Study Design: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. Results: Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p <0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p <0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m2, p = 0.01), higher EuroSCORE (median, 15% vs 6%, p <0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p <0.001), and peripheral vascular disease (16% vs 12%, p <0.001). Hyponatremia increased overall (24% vs 18.2%, p <0.001) and late mortality (18.6% vs 13.9%, p <0.001) and length of stay (LOS; 11 vs 7 days, p <0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p <0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p <0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p <0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p <0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001). Conclusions: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.

AB - Background: The association between postoperative hyponatremia (Na <135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. Study Design: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. Results: Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p <0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p <0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m2, p = 0.01), higher EuroSCORE (median, 15% vs 6%, p <0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p <0.001), and peripheral vascular disease (16% vs 12%, p <0.001). Hyponatremia increased overall (24% vs 18.2%, p <0.001) and late mortality (18.6% vs 13.9%, p <0.001) and length of stay (LOS; 11 vs 7 days, p <0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p <0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p <0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p <0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p <0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001). Conclusions: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.

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