Extended length of stay after elective ascending aortic surgery and associated risk factors

OBJECTIVE: Surgery on the ascending aorta incurs greater risk than other cardiac procedures. The primary aim of this study is to identify pre-operative and operative risk factors that play a role in extended length of stay (LOS) after elective surgery for ascending aortic aneurysms. The secondary aim is to determine post-operative outcomes associated with extended LOS.
METHODS: Patients who underwent elective surgery aged >18 between January 2018 and December 2019 for ascending aortic aneurysm with or without concomitant interventions in a single heart surgery center were retrospectively identified. Patients with days of hospital stay longer than the median length made up the extended stay group. The extended stay group was compared against the rest of the patients for demographics and operative parameters, as well as post-operative outcomes.
RESULTS: Patients with extended LOS were older (60.0±12.2 vs. 54.0±14.2, p=0.001) with more frequent coronary artery disease (CAD)(47.2% vs. 23.7%, p<0.001) and chronic obstructive pulmonary disease (COPD) (25.0% vs. 11.9% p=0.013). More patients in the extended LOS group required HCA for distal aortic anastomosis (43.5% vs. 17.5%, p<0.001) and cardiopulmonary bypass (CPB) durations were longer (283.1±83.9 vs. 225.3±84.2 min, p<0.001). Multivariate analysis revealed age, CAD, COPD, HCA, and CPB time as risk factors for extended LOS. Extended LOS patients had longer mechanical ventilation times (23.0±21.3 vs. 13.6±5.3 h, p<0.001), more frequently had acute renal failure (24.2% vs. 6.7%, p<0.001), reoperation for bleeding (20.7% vs. 6.7%, p=0.003), and stroke (14.3% vs. 4.3%, p=0.011).
CONCLUSION: In elective surgery for ascending aortic aneurysms older age, history of COPD and CAD, longer CPB times, and HCA during surgery are associated with extended LOS. Further studies are needed to investigate the association of prolonged hospital stay with long-term outcomes, as well as the impact of operation type on hospital stay.

Elektif Asendan Aort Cerrahisi Sonrasý Uzamýþ Hastane Yatýþý ve Ýliþkili Risk Faktörleri

Amaç: Asendan aort cerrahisi diðer kardiyak cerrahilere göre daha yüksek risk içerir. Çalýþmanýn birinci amacý asendan aort cerrahisi için elektif ameliyatlardan sonra uzun hastane yatýþý ile iliþkili preoperatif ve operatif risk faktörlerinin belirlenmesidir. Ýkincil amaç uzun hastane yatýþý ile hangi ameliyat sonrasý sonuçlarýn iliþkili olduðunun saptanmasýdýr.
Yöntem: Ocak 2018 – Aralýk 2019 arasýnda merkezimizde asendan aort cerrahisi için elektif operasyon yapýlan 18 yaþ üstü hastalar retrospektif olarak belirlendi. Medyan yatýþ süresinden uzun yatýþ süresi olan hastalar uzamýþ yatýþ grubunu oluþturdu. Bu grup ile diðer hastalar demografik, operatif ve postoperatif parametler açýsýndan karþýlaþtýrýldý.
Bulgular: Uzun yatýþ hastalarýnýn yaþlarý daha yüksek (60.0 ± 12.2 vs 54.0 ± 14.2, p=0.001), koroner arter hastalýðý (KAH) (47.2% vs 23.7%, p<0.001), kronik obstrüktif akciðer hastalýðý (KOAH) (25.0% vs 11.9% p=0.013) sýklýklarý daha fazlaydý. Uzamýþ yatýþ grubunda sirkulatuvar arrest gerektiren hastalar daha fazlaydý (43.5% vs 17.5%, p<0.001) ve kardiyopulmoner baypas (KPB) süresi daha uzundu (283.1 ± 83.9 vs 225.3 ± 84.2 dk, p<0.001). Çok deðiþkenli analiz ile yaþ, KAH, KOAH, sirkulatuvar arrest ve KPB süresi uzamýþ yatýþ için risk faktörü olarak saptandý. Uzamýþ yatýþ grubunda mekanik ventilasyon süresi daha uzun (23.0 ± 21.3 vs 13.6 ± 5.3 saat, p<0.001), akut böbrek yetmezliði (24.2% vs 6.7%, p<0.001), kanama nedeniyle tekrar ameliyat gereksinimi (20.7% vs 6.7%, p=0.003) ve inme (14.3% vs 4.3%, p=0.011) daha sýktý.
Sonuç: Elektif asendan aort cerrahisinde ileri yaþ, KOAH, KAH, uzun CPB süresi ve sirkulatuvar arrest uzamýþ yatýþ ile iliþkiliydi. Uzamýþ hastane yatýþýnýn uzun dönem sonuçlara etkisinin belirlenmesi için uzun takip süreli çalýþmalara ihtiyaç vardýr. (NCI-2021-3-52/R1)