Camilo Molineros Barón, Daniel Fernando Rodríguez Camacho, Andrea Duque López, Julián Serrano Giraldo, Williams Cervera Cadena, Oscar Mauricio Muñoz Velandia
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引用次数: 0
Abstract
Introduction: The relationship between intraoperative fluid balance and surgical reintervention in patients undergoing cardiac surgery is currently unclear.
Methods: Case‒control study nested in a historical cohort. Patients over 18 years of age in the immediate postoperative period of cardiac surgery were included, and unplanned surgical reintervention was evaluated as the primary outcome. Four groups were created according to intraoperative fluid balance. We performed a univariate analysis comparing patients who underwent reintervention (cases) with those who did not (controls), and a multivariate conditional logistic regression model controlling for multiple confusion variables.
Results: In total, 304 patients were analyzed (76 cases and 228 controls). The median age was 67 years, and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was greater in cases than in controls (2.05 (1.21-3.48) vs. 2.5 (1.46-4.63), p = 0.016). A greater proportion of smokers were found in cases (36.8% vs. 15.3%, p < 0.01). No differences were found in fluid balance between groups. Moreover, no differences were found according to the type of procedure performed given the match. The total duration of surgery was longer in reintervened patients (median 4 h (interquartile range (IQR) 3.66-5) vs. 5 h (IQR 4-5.11), p = 0.04). According to multivariate analysis, no association was found between fluid balance and the risk of requiring reintervention (odds ratio (OR) 1.03, confidence interval (CI) 0.86-1.23, p = 0.75). However, reintervention was associated with smoking (OR 4.44; CI 2.09-9.44; p < 0.01) and total duration of the surgical procedure (OR 1.39; CI 1.06-1.82; p < 0.01). The type of programming (urgent surgery) (OR 0.34; CI 0.16-0.74; p < 0.01) and history of acute myocardial infarction in the last 7 days (OR 0.46; CI 0.21-0.99; p = 0.04) were more frequent in patients who did not undergo reintervention.
Conclusion: Our findings did not reveal an association between a positive intraoperative fluid balance and the incidence of unplanned reintervention after cardiac surgery.
Graphical abstract:
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01935-6.
导言：心脏手术患者术中体液平衡与手术再干预之间的关系目前尚不清楚。方法：在历史队列中嵌套病例对照研究。纳入年龄在18岁以上的心脏手术术后患者，评估非计划手术再干预作为主要结局。根据术中体液平衡情况分为四组。我们进行了单因素分析，比较了接受再干预的患者（病例）和未接受再干预的患者（对照组），并采用了控制多个混淆变量的多因素条件逻辑回归模型。结果：共分析304例患者（76例，228例对照）。中位年龄为67岁，欧洲心脏手术风险评估系统（EuroSCORE） II评分高于对照组（2.05（1.21-3.48）比2.5 (1.46-4.63),p = 0.016）。病例中吸烟者的比例更高（36.8%比15.3%,p p = 0.04）。根据多变量分析，液体平衡与需要再干预的风险之间没有关联（优势比（OR） 1.03，置信区间（CI） 0.86-1.23, p = 0.75）。然而，再干预与吸烟相关(OR 4.44；可信区间2.09 - -9.44;P P P P = 0.04)在未接受再干预的患者中更为常见。结论：我们的研究结果并未揭示术中液体平衡阳性与心脏手术后意外再干预发生率之间的关联。图片摘要：补充信息：在线版本包含补充资料，可在10.1007/s12055-025-01935-6获得。
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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