• Chest · Oct 2024

    Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study.

    • JuJae-WooJWDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea., Jaeyeon Chung, Gang Heo, Youn Joung Cho, Yunseok Jeon, and Karam Nam.
    • Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
    • Chest. 2024 Oct 18.

    BackgroundEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.Research QuestionDoes perioperative PAC use decrease 1-year all-cause mortality in patients undergoing cardiac surgery?.Study Design And MethodsThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020, using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively), using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.ResultsA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted OR, 0.81; 95% CI, 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction < .001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality after isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared with the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (< 100 cases/y; OR, 0.70; 95% CI, 0.65-0.76).InterpretationPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was driven predominantly by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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