Trends in the Utilization of Multiorgan Support Among Adults Undergoing High-risk Cardiac Surgery in the United States
Issued Date
2024-01-01
Resource Type
ISSN
10530770
eISSN
15328422
Scopus ID
2-s2.0-85196934973
Journal Title
Journal of Cardiothoracic and Vascular Anesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Cardiothoracic and Vascular Anesthesia (2024)
Suggested Citation
Cobert J., Frere Z., Wongsripuemtet P., Ohnuma T., Krishnamoorthy V., Fuller M., Chapman A.C., Yaport M., Ghadimi K., Bartz R., Raghunathan K. Trends in the Utilization of Multiorgan Support Among Adults Undergoing High-risk Cardiac Surgery in the United States. Journal of Cardiothoracic and Vascular Anesthesia (2024). doi:10.1053/j.jvca.2024.04.038 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/99367
Title
Trends in the Utilization of Multiorgan Support Among Adults Undergoing High-risk Cardiac Surgery in the United States
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: To examine trends in the prevalence of multiorgan dysfunction (MODS), utilization of multi-organ support (MOS), and mortality among patients undergoing cardiac surgery with MODS who received MOS in the United States. Design: Retrospective cohort study. Setting: 183 hospitals in the Premier Healthcare Database. Participants: Adults ≥18 years old undergoing high-risk elective or non-elective cardiac surgery. Interventions: none. Measurements and Main Results: The exposure was time (consecutive calendar quarters) January 2008 and June 2018. We analyzed hospital data using day-stamped hospital billing codes and diagnosis and procedure codes to assess MODS prevalence, MOS utilization, and mortality. Among 129,102 elective and 136,190 non-elective high-risk cardiac surgical cases across 183 hospitals, 10,001 (7.7%) and 21,556 (15.8%) of patients developed MODS, respectively. Among patients who experienced MODS, 2,181 (22%) of elective and 5,425 (25%) of non-elective cardiac surgical cases utilized MOS. From 2008-2018, MODS increased in both high-risk elective and non-elective cardiac surgical cases. Similarly, MOS increased in both high-risk elective and non-elective cardiac surgical cases. As a component of MOS, mechanical circulatory support (MCS) increased over time. Over the study period, risk-adjusted mortality, in patients who developed MODS receiving MOS, increased in high-risk non-elective cardiac surgery and decreased in high-risk elective cardiac surgery, despite increasing MODS prevalence and MOS utilization (p<0.001). Conclusions: Among patients undergoing high-risk cardiac surgery in the United States, MODS prevalence and MOS utilization (including MCS) increased over time. Risk-adjusted mortality trends differed in elective and non-elective cardiac surgery. Further research is necessary to optimize outcomes among patients undergoing high-risk cardiac surgery.