10.5061/DRYAD.9236NG5
Shah, Aalap C.
University of Washington Medical Center
Ma, Kevin
University of Washington Medical Center
Faraoni, David
University of Toronto
Oh, Daniel C.S.
Rooke, G. Alec
University of Washington Medical Center
Van Norman, Gail A.
University of Washington Medical Center
Oh, Daniel C. S.
University of Washington
Data from: Self-reported functional status predicts post-operative
outcomes in non-cardiac surgery patients with pulmonary hypertension
Dryad
dataset
2019
Pulmonary hypertension
post-operative outcomes
2019-08-14T00:00:00Z
2019-08-14T00:00:00Z
en
https://doi.org/10.1371/journal.pone.0201914
951174 bytes
1
CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
BACKGROUND: Pulmonary hypertension (PHTN) is associated with increased
post-procedure morbidity and mortality. Pre-procedure echocardiography
(ECHO) is a widely used tool for evaluation of these patients, but its
accuracy in predicting post-procedure outcomes is unproven. Self-reported
exercise tolerance has not been evaluated for operative risk
stratification of PHTN patients. OBJECTIVE: We analyzed whether
self-reported exercise tolerance predicts outcomes (hospi-tal
length-of-stay [LOS], mortality and morbidity) in PHTN patients (WHO Class
I - V) under-going anesthesia and surgery. METHODS AND FINDINGS: We
reviewed 550 non-cardiac, non-obstetric procedures per-formed on 370 PHTN
patients at a single institution between 2007 and 2013. All patients had
cardiac ECHO documented within 1 year prior to the procedure.
Pre-procedure comorbidities and ECHO data were collected. Functional
status (< or ? 4 metabolic equivalents of task [METs]) was assigned
based on responses to standard patient interview questions during the
pre-anesthesia clinic visit. Multiple logistic regression was used to
develop a risk score model (Pul-monary Hypertension Outcome Risk Score;
PHORS) and determine its value in predicting post-procedure outcomes. In
an adjusted model, functional status <4 METs was independently
associ-ated with a LOS >7 days (p < .003), as were higher
ASA class (p < .002), open surgical approach (p < .002),
procedure duration > 2 hours (p < .001), and the absence of
systemic hypertension (p = .012). PHORS Score ?2 was associated with an
increased 30-day major complication rate (28.7% vs. 19.2%; p <
0.001) and ICU admission rate (8.6% s 2.8%; p = .007), but no statistical
difference in hospital readmissions rate (17.6% vs. 14.0%; p = .29), or
mortality (3.5% vs. 1.4%; p = .75). Similar ECHO findings did not further
improve outcome prediction. CONCLUSIONS: Poor functional status is
associated with severe PHTN and predicts increased LOS and post-procedure
complications in patients with moderate to severe pulmonary hyperten-sion
with different etiologies. A risk assessment model predicts increased LOS
with fair accura-cy. A thorough evaluation of underlying etiologies of
PHTN should be undertaken in every pa-tient.
PHTN 8.14.18 Final DatasetExcel Spreadsheet with individual cases per row,
and data variables (dichotomous variables as well as continuous variables)
organized by column. Columns with outcomes or potential scoring criteria
highlighted in orange and green.
Seattle
WA