Changes in central venous saturation after major surgery, and association with outcome

Rupert Pearse, Deborah Dawson, Jayne Fawcett, Andrew Rhodes, R Michael Grounds, E David Bennett, Rupert Pearse, Deborah Dawson, Jayne Fawcett, Andrew Rhodes, R Michael Grounds, E David Bennett

Abstract

Introduction: Despite recent interest in measurement of central venous oxygen saturation (ScvO2), there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome.

Methods: ScvO2 and other biochemical, physiological and demographic data were prospectively measured for 8 hours after major surgery. Complications and deaths occurring within 28 days of enrollment were included in the data analysis. Independent predictors of complications were identified with the use of logistic regression analysis. Optimum cutoffs for ScvO2 were identified by receiver operator characteristic analysis.

Results: Data from 118 patients was analysed; 123 morbidity episodes occurred in 64 these patients. There were 12 deaths (10.2%). The mean +/- SD age was 66.8 +/- 11.4 years. Twenty patients (17%) underwent emergency surgery and 77 patients (66%) were male. The mean +/- SD P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity) score was 38.6 +/- 7.7, with a predicted mortality of 16.7 +/- 17.6%. After multivariate analysis, the lowest cardiac index value (odds ratio (OR) 0.58 (95% confidence intervals 0.37 to 0.9); p = 0.018), lowest ScvO2 value (OR 0.94 (0.89 to 0.98); p = 0.007) and P-POSSUM score (OR 1.09 (1.02 to 1.15); p = 0.008) were independently associated with post-operative complications. The optimal ScvO2 cutoff value for morbidity prediction was 64.4%. In the first hour after surgery, significant reductions in ScvO2 were observed, but there were no significant changes in CI or oxygen delivery index during the same period.

Conclusion: Significant fluctuations in ScvO2 occur in the immediate post-operative period. These fluctuations are not always associated with changes in oxygen delivery, suggesting that oxygen consumption is also an important determinant of ScvO2. Reductions in ScvO2 are independently associated with post-operative complications.

Figures

Figure 1
Figure 1
Central venous saturation (ScvO2) in the 8 hours after major surgery. Results are means ± SD. *p < 0.0001 for low ScvO2 group; p = 0.02 for high ScvO2 group. The difference between the high and low groups is significant overall and for each individual time point (p < 0.0001).
Figure 2
Figure 2
Oxygen delivery index (DO2I) in the 8 hours after major surgery. Results are means ± SD. The difference between the group with high central venous saturation (ScvO2) and the low ScvO2 group is significant overall (p = 0.005) but not for individual time points 7 and 8.

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