• Maria Tafelmeier, Lili Luft, Elisabeth Zistler, Bernhard Floerchinger, Daniele Camboni, Marcus Creutzenberg, Florian Zeman, Christof Schmid, Lars Siegfried Maier, Stefan Wagner, and Michael Arzt.
• Department of Internal Medicine II (Cardiology, Pneumology, and Intensive Care), University Medical Center Regensburg, Regensburg, Germany. Electronic address: maria.tafelmeier@ukr.de.
• Chest. 2021 Feb 1; 159 (2): 798-809.

BackgroundPostoperative major pulmonary complications (MPCs) continue to be leading causes of increased morbidity and death after cardiac surgery. Although various risk factors have been identified, reports on the association between sleep-disordered breathing (SDB) and postoperative MPCs remain inconclusive.Research QuestionWhat is the incidence of the composite end point postoperative MPCs? What are predictors for postoperative MPCs in patients without SDB, with OSA, and with central sleep apnea (CSA) who undergo cardiac surgery?Study Design And MethodsIn this subanalysis of the ongoing prospective observational study "Impact of Sleep-disordered breathing on Atrial Fibrillation and Perioperative complications in Patients undergoing Coronary Artery Bypass grafting Surgery (CONSIDER AF)," preoperative risk factors for postoperative MPCs were examined in 250 patients who underwent cardiac surgery. Postoperative MPCs (including respiratory failure, acute respiratory distress syndrome, pneumonia, or pulmonary embolism) were registered prospectively within the first seven postoperative days. Presence and type of SDB were assessed the night prior to surgery with the use of portable SDB-monitoring.ResultsPatients with SDB experienced significantly more often postoperative MPCs than patients without SDB (24% vs 7%; P < .001). Multivariable logistic regression analysis showed that CSA (OR, 4.68 [95% CI, 1.78-12.26]; P = .002), heart failure (OR, 2.65 [95% CI, 1.11-6.31]; P = .028), and a history of transient ischemic attack or stroke (OR, 2.73 [95% CI, 1.07-6.94]; P = .035) were associated significantly with postoperative MPCs. Compared with patients without MPCs, those with postoperative MPCs had a significantly longer hospital stay (median days, 9 [25th/75th percentile, 7/13] vs 19 [25th/75th percentile, 11/38]; P < .001).InterpretationAmong established risk factors for postoperative MPCs, CSA, heart failure, and history of transient ischemic attack or stroke were associated significantly with postoperative MPCs. Our findings contribute to the identification of patients who are at high-risk for postoperative MPCs.Clinical Trial RegistrationClinicalTrials.gov identifier NCT02877745.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

17 keywords...

hide…