• Julien Cobert, Zachary Frere, Pattrapun Wongsripuemtet, Tetsu Ohnuma, Vijay Krishnamoorthy, Matthew Fuller, Allyson C Chapman, Miguel Yaport, Kamrouz Ghadimi, Raquel Bartz, and Karthik Raghunathan.
• Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA; Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: Julien.Cobert@ucsf.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 1; 38 (9): 198719951987-1995.

ObjectivesTo examine trends in the prevalence of multiorgan dysfunction (MODS), utilization of multi-organ support (MOS), and mortality among patients undergoing cardiac surgery with MODS who received MOS in the United States.DesignRetrospective cohort study.Setting183 hospitals in the Premier Healthcare Database.ParticipantsAdults ≥18 years old undergoing high-risk elective or non-elective cardiac surgery.Interventionsnone.Measurements And Main ResultsThe exposure was time (consecutive calendar quarters) January 2008 and June 2018. We analyzed hospital data using day-stamped hospital billing codes and diagnosis and procedure codes to assess MODS prevalence, MOS utilization, and mortality. Among 129,102 elective and 136,190 non-elective high-risk cardiac surgical cases across 183 hospitals, 10,001 (7.7%) and 21,556 (15.8%) of patients developed MODS, respectively. Among patients who experienced MODS, 2,181 (22%) of elective and 5,425 (25%) of non-elective cardiac surgical cases utilized MOS. From 2008-2018, MODS increased in both high-risk elective and non-elective cardiac surgical cases. Similarly, MOS increased in both high-risk elective and non-elective cardiac surgical cases. As a component of MOS, mechanical circulatory support (MCS) increased over time. Over the study period, risk-adjusted mortality, in patients who developed MODS receiving MOS, increased in high-risk non-elective cardiac surgery and decreased in high-risk elective cardiac surgery, despite increasing MODS prevalence and MOS utilization (p<0.001).ConclusionsAmong patients undergoing high-risk cardiac surgery in the United States, MODS prevalence and MOS utilization (including MCS) increased over time. Risk-adjusted mortality trends differed in elective and non-elective cardiac surgery. Further research is necessary to optimize outcomes among patients undergoing high-risk cardiac surgery.Published by Elsevier Inc.

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