RT Journal Article
SR Electronic
T1 Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1302
OP 1307
DO 10.1183/09031936.00089212
VO 41
IS 6
A1 Stephanie Meyer
A1 Vallerie V. McLaughlin
A1 Hans-Juergen Seyfarth
A1 Todd M. Bull
A1 Carmine D. Vizza
A1 Mardi Gomberg-Maitland
A1 Ioana R. Preston
A1 Joan A. Barberà
A1 Paul M. Hassoun
A1 Michael Halank
A1 Xavier Jaïs
A1 Nils Nickel
A1 Marius M. Hoeper
A1 Marc Humbert
YR 2013
UL http://erj.ersjournals.com/content/41/6/1302.abstract
AB We conducted an international, prospective, 3-year questionnaire-based survey among 11 pulmonary hypertension centres to assemble data from patients with pulmonary arterial hypertension (PAH) undergoing noncardiac and nonobstetric surgery. Data were collected between July 2007 and June 2010 from 114 patients with PAH (70% female, mean age 57 years) who underwent major surgery. At the time of surgery, 43% were in functional class III/IV. 82% of the interventions were performed under general anaesthesia and 18% under spinal anaesthesia. Major complications occurred in seven (6.1%) of the patients, of whom four died, resulting in an overall perioperative mortality rate of 3.5%. The mortality rate was 15% (two out of 13) in emergency procedures, compared with 2% (two out of 101) in nonemergency procedures (p=0.01). Risk factors for major complications were an elevated right atrial pressure (OR 1.1, 95% CI 1.0–1.3; p=0.01), a 6-min walking distance <399 m at the last preoperative assessment (OR 2.2, 95% CI 1.1–3.7; p=0.04), the perioperative use of vasopressors (OR 1.5, 95% CI 1.2–2.7; p=0.03) and the need for emergency surgery (OR 2.4, 95% CI 1.4–3.6; p=0.01). Major surgery in patients with PAH continues to be a high-risk procedure, particularly when emergency interventions are needed.