Τούτουζας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κυρίτση Ελένη, Ομότιμη Καθηγήτρια, Νοσηλευτική,Πανεπιστήμιο Δυτικής Αττικής
Τούσουλης Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Introduction: Cardiovascular disease is one of the most critical intra and postoperative risk factor among patients that are operated for non-cardiovascular diseases and is responsible for perioperative morbidity and mortality especially after major surgical procedures.
Purpose: The aim of the study was the estimation of the incidence of peri-and postoperative complications in cardiologically affected patients, that are operated for non-cardiological procedures.
Method and material: The sample of the study consisted 615 patients with cardiovascular diseases who were operated in the First Propaedeutic Surgical Clinic of University of Athens in Hippokrateion General hospital, from December 2015 until July 2016. Data were collected from patients database and were recorded in a special form that was made for the study’s purpose. Demographic, clinical preoperative, intraoperative and post-operative patients data were collected. Statistical analysis was made using x2 test and the statistically significance level was set at 0.05.
Results : Of the 615 participants, 54.6% were male 29.0% of the patients were <65 years old, 31% 66-75 years old and the rest 40%was above 76 years of age. 39,3% of the patients suffered from Cancer except Breast Cancer, 12,8% of the patients were operated for Breast Cancer and the rest of the patients 47,8% were operated for non carcinomatous diseases. Coronary disease was found in 30% of the patients. 12,5% of the patients had a history of coronary artery bypass surgery (CABG). 91,9% suffered from high blood pressure, 37,8% had increased cholesterol levels, 26,7% of the patients had a history of diabetes mellitus, 19,2% suffered from atrial fibrillation. Anticoagulant medications was received by 38,5% of the patients. Patients over 76 years old were statistically related with higher mortality rates p=0,035. Patients suffering from Cancer had more complications p<0,001. Patients who were urgently hospitalized had also an ICU stay more, frequent than the others one p=0,018 as well greater mortality rates p=0,011.
Other statistically significant factors that were related with an ICU stay were patients with coronary disease atrial fibrillation, anticoagulant therapy, aortic valve stenosis and cardiac output <50%, p=0,002, p=0,042, p=0,044, p<0,001, p=0,044 respectively. Complications rates as well as mortality rates were elevated among patients with cholesterol levels imbalance p=0,020,p=0,008 respectively.
On the other hand complications rates were higher among patients with 3C type of operations p<0,001 especially the first 15 post-operative days p<0,001. The majority of the complications were treated with non-surgical therapist among patients that were categorized as Clavien Dindo lllb,lV,V p<0,001 and they also had an ICU stay early postoperatively p<0,001.
As for as the clinical incidence of the patients and their demographics, no statistically significant difference was found when comparing the incidence of cardiovascular and the non-cardiovascular complications.
Conclusions: As for as the clinical incidence of the patients and their demographics, no statistically significant difference was found when comparing the incidence of cardiovascular and the non-cardiovascular complications. Post-operative complications are more often related to age, severity of concomitant diseases and the cause and type of surgery.