The predictive and prognostic value of risk factors in patients receiving hybrid coronary revascularization with postoperative pulmonary complications

Shanshan Mu; Yingqi Chen; Jiawan Wang; Jingjing Guo; Ruitong Niu; Yang Zhang; Pixiong Su; Jason M Ali; Jie Gao; Anshi Wu

doi:10.21037/jtd-24-422

The predictive and prognostic value of risk factors in patients receiving hybrid coronary revascularization with postoperative pulmonary complications

J Thorac Dis. 2024 Apr 30;16(4):2528-2538. doi: 10.21037/jtd-24-422. Epub 2024 Apr 25.

Authors

Shanshan Mu^#¹, Yingqi Chen^#¹, Jiawan Wang¹, Jingjing Guo¹, Ruitong Niu¹, Yang Zhang¹, Pixiong Su², Jason M Ali³, Jie Gao², Anshi Wu¹

Affiliations

¹ Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China.
² Department of Cardiac Surgery, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China.
³ Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK.

^# Contributed equally.

Abstract

Background: The mortality rate of coronary artery disease ranks first in developed countries, and coronary revascularization therapy is an important cornerstone of its treatment. The postoperative pulmonary complications (PPCs) in patients receiving one-stop hybrid coronary revascularization (HCR) aggravate the dysfunction of multiple organs such as the heart and lungs, therefore increasing mortality. However, the risk factors are still unclear. The objective of this study was to explore the risk factors of PPCs after HCR surgery.

Methods: In this study, the perioperative data of 311 patients undergoing HCR surgery were reviewed. All patients were divided into two groups according to whether the PPCs occurred. The baseline information and surgery-related indicators in preoperative laboratory examination, intraoperative fluid management, and anesthesia management were compared between the two groups.

Results: Advanced age [odds ratio (OR): 1.065, 95% confidence interval (CI): 1.030-1.101, P<0.001], high body mass index (BMI; OR: 1.113, 95% CI: 1.011-1.225, P=0.02), history of percutaneous coronary intervention (PCI) surgery (OR: 2.831, 95% CI: 1.388-5.775, P=0.004), one-lung volume ventilation (OR: 3.804, 95% CI: 1.923-7.526, P<0.001), inhalation of high concentration oxygen (OR: 3.666, 95% CI: 1.719-7.815, P=0.001), the application of positive end-expiratory pressure (PEEP; OR: 2.567, 95% CI: 1.338-4.926, P=0.005), and long one-lung ventilation time (OR: 1.015, 95% CI: 1.006-1.023, P=0.001) may be risk factors for postoperative PPCs in patients undergoing one-stop coronary revascularization surgery. Using the above seven factors to jointly predict the risk of PPCs in patients undergoing one-stop coronary revascularization surgery, the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) =0.873, 95% CI: 0.835-0.911, sensitivity: 84.81%, and specificity: 75.82%; the predictive model was shown to be effective.

Conclusions: Patients undergoing HCR surgery with advanced age, high BMI, a history of PCI surgery, one-lung volume ventilation, inhalation of high concentration oxygen, use of PEEP, and prolonged single lung ventilation are more prone to PPCs.

Keywords: One-stop hybrid coronary revascularization (one-stop HCR); postoperative pulmonary complications (PPCs); risk factor.