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Cerebral Oximetry During Adult Cardiac Surgery Is Associated With Improved Postoperative Outcomes
Karthik Raghunathan1, Daryl Kerr1, Ying Xian2
1Duke University Medical Center, Durham, NC.
Insights
Intraoperative cerebral oximetry (CeOx) use in adult cardiac surgery was linked to reduced major organ morbidity and mortality (MOMM). Further clinical trials are recommended due to common, correctable desaturation events.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Major organ morbidity and mortality (MOMM) remain significant concerns following adult cardiac surgery.
- Intraoperative cerebral oximetry (CeOx) is a monitoring tool aimed at optimizing cerebral oxygenation.
- The impact of CeOx on patient outcomes in large-scale cardiac surgery populations requires further elucidation.
Purpose of the Study:
- To investigate the association between intraoperative cerebral oximetry (CeOx) and major organ morbidity and mortality (MOMM) in adult cardiac surgery patients.
- To assess the effectiveness of CeOx in reducing adverse outcomes in a diverse cardiac surgery cohort.
Main Methods:
- A retrospective, multicenter cohort study utilizing the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011-December 2016).
- Inclusion criteria encompassed adult patients undergoing major cardiac procedures with cardiopulmonary bypass.
- Propensity score-based matching was employed to compare outcomes between CeOx recipients and non-recipients.
Main Results:
- Analysis included over 1.19 million adult cardiac surgery patients, with approximately 30% receiving intraoperative CeOx.
- Matched analysis (n=360,285 pairs) revealed significantly lower rates of MOMM in the CeOx group compared to the non-CeOx group (p < 0.0001).
- The greatest benefit was observed in patients undergoing aortic valve repair/replacement, with a number needed to treat of 227 for MOMM reduction, though ICU stay >72 hours was higher with CeOx.
Conclusions:
- Intraoperative cerebral oximetry is associated with a significant reduction in major organ morbidity and mortality after adult cardiac surgery.
- The findings support the use of CeOx as a valuable monitoring tool in this patient population.
- A large-scale clinical trial is warranted to confirm these findings, given the frequency of correctable desaturation events observed.
Objective:
To examine the association/effect of intraoperative cerebral oximetry (CeOx) on major organ morbidity and mortality (MOMM) after adult cardiac surgery.
Design:
A retrospective, multicenter cohort study.
Setting:
Patients treated at any hospital within the Society of Thoracic Surgeons Adult Cardiac Surgery Database between July 1, 2011, and December 31, 2016, with a 30-day postoperative follow-up.
Participants:
Individuals ≥18 years old undergoing isolated coronary artery bypass graft (CABG) or valve repair or replacement, or any combination of procedures with cardiopulmonary bypass.
Interventions:
Intraoperative CeOx.
Measurements And Main Results:
MOMM includes operative mortality, stroke, renal failure, prolonged mechanical ventilation, deep sternal wound infection, or reoperation for any reason within 30 days. Of 1.19 million patients who met inclusion criteria within 1,180 facilities, ∼30% (n = 361,124) received CeOx versus nonrecipients (n = 838,675) with similar baseline patient characteristics. Using a propensity score-based 1:1 greedy matching method, 99.7% of CeOx recipients (n = 360,285) were matched with nonrecipients. The rates of MOMM were lower with versus without CeOx. The absolute risk reduction translated to a number needed to treat of 227 patients (95% CI: 166-363, p < 0.0001). In sensitivity analyses of prespecified subgroups, the benefit was strongest among patients undergoing aortic valve repair or replacement ± CABG (more than 7 fewer MOMM events per 1,000, p < 0.0001). However, intensive care unit stay >72 hours was higher with CeOx.
Conclusion:
Intraoperative cerebral oximetry is associated with less major organ morbidity and mortality after adult cardiac surgery. A large-scale clinical trial is warranted, given that desaturation is common and correctable.
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