Abstract 12074: Perioperative Morbidity and Mortality in Patients with Pulmonary Hypertension Undergoing Noncardiac Surgery
Introduction: An increasing number of patients with pulmonary hypertension (PH) are presenting for non-cardiac surgical procedures. Despite this, few population level analyses are available to guide perioperative risk stratification and planning. Hypothesis: There are subsets of patients with PH who are at increased risk for morbidity and mortality following non-cardiac surgery.
Methods: A matched case-control study was performed using the Nationwide Inpatient Sample for the years 2005-2009. Patients with ICD-9 coding for primary or idiopathic PH (416.0) and those with secondary or associated PH (416.8) were identified and matched 3:1 to control patients using age, sex, race, year, surgical procedure, elective admission status, hospital type, and comorbidity index. Patients with missing matching variables were excluded. Chi-squared or Wilcoxon tests were used to compare outcomes.
Results: A total of 10,204,308 records involving major procedures were examined. Of these, 8,651,266 (84.8%) were non-cardiac; 6,338,573 (62.1%) containing necessary matching variables were retained for analysis. A PH diagnosis was coded in 39,174 records (0.62%). The diagnosis of primary or idiopathic PH (416.0) was associated with higher rates of in-hospital mortality (9% vs. 6% p<0.001), longer average hospital stay (13.8 vs. 11.0 days p<0.001), and increased average hospital charges ($101,511 vs. $81,812 p<0.001) compared to matched controls. There was no association between an ICD-9 diagnosis of 416.8 and any of the perioperative outcomes.
Conclusions: A diagnosis of primary or idiopathic PH conveys significantly higher risks of perioperative mortality and morbidity compared to well-matched controls. In contrast, a diagnosis of secondary or associated PH is not associated with substantially increased morbidity or mortality. Perioperative planning and management should include explicit consideration of the etiology of pulmonary hypertension.
- © 2012 by American Heart Association, Inc.