Pulmonary Complications After Cardiac Surgical Procedures: A Tertiary Centre Audit of Elective and Urgent Cases

Inadequate time for preoperative optimization can lead to adverse outcomes after urgent cardiac surgical procedures. In this audit, we compared the incidence of postoperative pulmonary complications (PPCs) and other adverse outcomes after elective and urgent cardiac surgical procedures.

Adult patients who underwent nonemergency open heart surgical procedures were included. PPCs were defined as a composite of atelectasis, pneumonia, acute respiratory distress syndrome, respiratory failure, and pulmonary aspiration. Logistic regression analysis identified factors associated with PPCs. Other pulmonary and systemic complications were examined.

In a sample of 6138 patients, PPCs were observed in 1996 (32.5%) participants. The urgent group had higher rates of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism compared with elective patients (P < .001). Mild and moderate-severe respiratory diseases were associated with PPCs (adjusted odds ratio [OR], 1.34; 95% CI, 1.14-1.58; P < .001 and OR, 1.66; 95% CI, 1.32-2.09; P < .001, respectively). Other associated factors included age (P = .006), coronary artery bypass surgery, obesity, reduced left ventricular ejection fraction, preoperative creatinine level, and perfusion time (P < .001).

Pulmonary complications increased after urgent compared with elective cardiac surgical procedures, with a higher incidence of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism.