Herko Grubitzsch1, Andreas Schäfer1, Benamin Claus1, Sascha Treskatsch2, Michael Sander2, Wolfgang Konertz1
1Klinik für Kardiovaskuläre Chirurgie, 2Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
Background and aim of the study: Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality. As treatment also demands substantial healthcare resources, a search was made for determinants of increased resource utilization.
Methods: Between 2000 and 2010, a total of 149 consecutive patients (107 males, 42 females; mean age 63.5 ± 13.8 years) underwent re-do surgery for PVE at the authors’ institution; 92 patients (61.7%) had aortic valve replacement, 42 (28.2%) had mitral valve replacement, and 15 (10.1%) had double valve replacement. Multivariate binary regression analysis was used to identify predictors of increased resource utilization, defined as mechanical ventilation (MV) >3 days, intensive care unit (ICU) stay >7 days, and hospital stay (HS) >42 days.
Results: Preoperatively, 14 patients (9.4%) presented with shock and 17 (11.4%) with acute renal failure. Ventilatory and pharmacological circulatory support was required in 17 (11.4%) and 19 (12.8%) patients, respectively. The logistic EuroSCORE was >20% in 121 patients (81.2%). Staphylococci were the most common infecting microorganisms (41 patients; 27.5%), while 53 cases (35.6%) were culture-negative. The operative, cardiopulmonary bypass and aortic
cross-clamp times were 259 ± 88.3 min, 149 ± 62.4 min, and 112 ± 44.3 min, respectively. Mechanical circulatory support (11 intra-aortic balloon pump; two right ventricular assist device; one left ventricular assist device) was required in 14 patients (9.4%). At 30 days, mortality was 12.8% (n = 17) and morbidity 78.5% (117 patients experienced at least one complication). At one, five and 10 years, the overall survival was 78.4 ± 3.5%, 76.7 ± 3.6% and 74.9 ± 3.8%, respectively. The duration of postoperative MV was 8 ± 20.7 days, while ICU and hospital stays were 11 ± 20.8 and 37 ± 30.2 days, respectively. The following predictors for increased resource utilization were identified: preoperative ventilatory support, mechanical circulatory support, recent myocardial infarction, and urgency for MV >3 days; preoperative ventilator support and mechanical circulatory support for ICU >7 days; and urgency and age for HS >42 days.
Conclusion: A critical preoperative state and perioperative mechanical circulatory were strongly predictive of increased resource utilization. Hence, if resource utilization is to be reduced, an early operation seems more appropriate than to postpone surgery until an uncertain or unattainable re-normalization of organ dysfunction becomes evident.
The Journal of Heart Valve Disease 2014;23:752-758
|Determinants for Increased Resource Utilization after Surgery for Prosthetic Valve Endocarditis|
Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.
Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.