TY - JOUR
T1 - Preoperative hyponatremia predicts outcomes 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.
N1 - Funding Information:
This work was supported by a research grant from Biogen Idec , Weston, MA.
Funding Information:
Conflicts of interest: Dr. Crestanello received a research grant from Biogen Idec , Weston, MA. Dr. Abraham has received a research grant and consulting fees from Biogen Idec , Weston, MA.
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/5/1
Y1 - 2013/5/1
N2 - Objective: To study the effect of preoperative hyponatremia (Na <135 mEq/L) on outcomes after cardiac surgery. Methods: From 2002 to 2008, 4370 patients had cardiac surgery at our institution (CABG in 2238, valve in 597, CABG valve in 537, other in 998). The institution electronic medical records, STS database, and Social Security death index data were analyzed. The association of hyponatremia with mortality, hospital length of stay (LOS), and complications was analyzed using regression analysis. Results: Prevalence of hyponatremia was 21%. Patients with preoperative hyponatremia had lower left ventricular ejection fraction (39% ± 17% versus 46% ± 14%, P < 0.001) and glomerular filtration rate (69 ± 32 mg/min/1.73 m2 versus 74 ± 27 mg/min/1.73 m2, P < 0.001) and higher median EuroSCORE (19% versus 9%, P < 0.001), NYHA class 3-4 (77% versus 65%, P < 0.001), prevalence of chronic obstructive pulmonary disease (25% versus 18%, P < 0.001), and arteriopathy (20% versus 13%, P < 0.001). Hyponatremia was associated with increased early mortality (9% versus 4%, P < 0.001), late mortality (24% versus 16%, P < 0.001), and LOS (13 versus 8 d, P < 0.001). Mortality increased with the severity of hyponatremia. After adjusting for baseline and operative variables, hyponatremia was associated with increased hazard of mortality (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.14-1.52, P < 0.001), risk of early mortality (odds ratio [OR] 1.52, 95% CI 1.09-2.12, P < 0.001), late mortality (HR 1.37, 95% CI 1.16-1.62, P < 0.001), LOS (multiplier 1.26, 95% CI 1.15-1.39, P < 0.001), operative complications (OR 1.30, 95% CI 1.00-1.69, P = 0.051), and dialysis (OR 1.64, 95% CI 1.11-2.44, P = 0.013). Conclusions: Preoperative hyponatremia is common, especially in high-risk patients. It is an independent risk factor for mortality, prolonged hospitalization, and complications after cardiac surgery.
AB - Objective: To study the effect of preoperative hyponatremia (Na <135 mEq/L) on outcomes after cardiac surgery. Methods: From 2002 to 2008, 4370 patients had cardiac surgery at our institution (CABG in 2238, valve in 597, CABG valve in 537, other in 998). The institution electronic medical records, STS database, and Social Security death index data were analyzed. The association of hyponatremia with mortality, hospital length of stay (LOS), and complications was analyzed using regression analysis. Results: Prevalence of hyponatremia was 21%. Patients with preoperative hyponatremia had lower left ventricular ejection fraction (39% ± 17% versus 46% ± 14%, P < 0.001) and glomerular filtration rate (69 ± 32 mg/min/1.73 m2 versus 74 ± 27 mg/min/1.73 m2, P < 0.001) and higher median EuroSCORE (19% versus 9%, P < 0.001), NYHA class 3-4 (77% versus 65%, P < 0.001), prevalence of chronic obstructive pulmonary disease (25% versus 18%, P < 0.001), and arteriopathy (20% versus 13%, P < 0.001). Hyponatremia was associated with increased early mortality (9% versus 4%, P < 0.001), late mortality (24% versus 16%, P < 0.001), and LOS (13 versus 8 d, P < 0.001). Mortality increased with the severity of hyponatremia. After adjusting for baseline and operative variables, hyponatremia was associated with increased hazard of mortality (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.14-1.52, P < 0.001), risk of early mortality (odds ratio [OR] 1.52, 95% CI 1.09-2.12, P < 0.001), late mortality (HR 1.37, 95% CI 1.16-1.62, P < 0.001), LOS (multiplier 1.26, 95% CI 1.15-1.39, P < 0.001), operative complications (OR 1.30, 95% CI 1.00-1.69, P = 0.051), and dialysis (OR 1.64, 95% CI 1.11-2.44, P = 0.013). Conclusions: Preoperative hyponatremia is common, especially in high-risk patients. It is an independent risk factor for mortality, prolonged hospitalization, and complications after cardiac surgery.
KW - Cardiac surgery
KW - Hyponatremia
KW - Mortality
KW - Outcomes
KW - Risk factors
KW - Serum sodium
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U2 - 10.1016/j.jss.2012.06.004
DO - 10.1016/j.jss.2012.06.004
M3 - Article
C2 - 22748596
AN - SCOPUS:84884212187
SN - 0022-4804
VL - 181
SP - 60
EP - 66
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -