Pulmonary artery catheter use in adult patients undergoing cardiac surgery: a retrospective, cohort study

Andrew D Shaw, Michael G Mythen, Douglas Shook, David K Hayashida, Xuan Zhang, Jeffrey R Skaar, Sloka S Iyengar, Sibyl H Munson, Andrew D Shaw, Michael G Mythen, Douglas Shook, David K Hayashida, Xuan Zhang, Jeffrey R Skaar, Sloka S Iyengar, Sibyl H Munson

Abstract

Background: The utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training. This US multi-center, retrospective electronic health record (EHR) database analysis was performed to identify associations between PAC use in adult cardiac surgeries and effects on subsequent clinical outcomes.

Methods: This cohort analysis utilized the Cerner Health Facts database to examine patients undergoing isolated coronary artery bypass graft (CABG), isolated valve surgery, aortic surgery, other complex non-valvular and multi-cardiac procedures, and/or heart transplant from January 1, 2011, to June 30, 2015. A total of 6844 adults in two cohorts, each with 3422 patients who underwent a qualifying cardiac procedure with or without the use of a PAC for monitoring purposes, were included. Patients were matched 1:1 using a propensity score based upon the date and type of surgery, hospital demographics, modified European System for Cardiac Operative Risk Evaluation (EuroSCORE II), and patient characteristics. Primary outcomes of 30-day in-hospital mortality, length of stay, cardiopulmonary morbidity, and infectious morbidity were analyzed after risk adjustment for acute physiology score.

Results: There was no difference in the 30-day in-hospital mortality rate between treatment groups (OR, 1.17; 95% CI, 0.65-2.10; p = 0.516). PAC use was associated with a decreased length of stay (9.39 days without a PAC vs. 8.56 days with PAC; p < 0.001), a decreased cardiopulmonary morbidity (OR, 0.87; 95% CI, 0.79-0.96; p < 0.001), and an increased infectious morbidity (OR, 1.28; 95% CI, 1.10-1.49; p < 0.001).

Conclusions: Use of a PAC during adult cardiac surgery is associated with decreased length of stay, reduced cardiopulmonary morbidity, and increased infectious morbidity but no increase in the 30-day in-hospital mortality. This suggests an overall potential benefit associated with PAC-based monitoring in this population.

Trial registration: The study was registered at clinicaltrials.gov (NCT02964026) on November 15, 2016.

Keywords: Cardiac surgery; Cardiopulmonary complications; Infectious complications; Length-of-stay; Major morbidity; Mortality; Pulmonary artery catheter (PAC).

Conflict of interest statement

The study was determined exempt from approval requirement by the Vanderbilt University Institutional Review Board prior to data extraction. Exemption was granted given the retrospective nature of the study within a de-identified database.Not applicable.ADS reports personal fees from Edwards Lifesciences during the conduct of the study, has served on medical advisory boards for Edwards Lifesciences, and has received personal fees from Astute Medical, FAST Biomedical, NxStage Medical, and Astellas outside of the submitted work. MGM reports personal fees from Edwards Lifesciences, grants and personal fees from Deltex Medical Ltd., and research grants from Smiths Medical outside of the submitted work; is on the editorial board of the British Journal of Anaesthesia and Critical Care; and is founding Editor-In-Chief of Perioperative Medicine. DS reports personal fees from Edwards Lifesciences, Boston Scientific, and LivaNova outside the submitted work. DKH, XZ, JRS, SSI, and SHM are consultants for Boston Strategic Partners, Inc., who received professional fees from Edwards for this study.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient selection and flow diagram
Fig. 2
Fig. 2
Propensity score matching of the study population. a Following the selection of patients with a qualifying cardiac procedure, patients were divided into two cohorts based on use (or non-use) of a PAC. b A propensity score-based match was performed with the PAC and no-PAC populations to generate matched cohorts of 3442 patients for analysis
Fig. 3
Fig. 3
Primary outcomes associated with PAC use in cardiac surgery. a In-hospital mortality determined for the first 30 days from index procedure date, cardiopulmonary morbidity, infectious disease morbidity, and b length of stay for 6844 propensity score-matched pairs; the plot shows a median box plot with interquartile range (IQR) in the box and whiskers of 1.5 × IQR

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