The effect of mask usage of the health personnel on blood gas analysis and cognitive strengthening during COVID-19 pandemic.

Objectives: To investigate the effect of lengthy mask use on blood gas values and cognitive functions. METHODS: The cross-sectional study was conducted in February and March 2022 at Mersin City Training and Research Hospital, Mersin, Turkey, and comprised healthcare professionals of either gender aged 20-60 years working in the 3rd level intensive care unit. Each volunteer was subjected to venous blood gas analysis at the beginning and end of the 8-hour morning shift. Coronavirus disease-2019 status was noted, and further data related to cognitive functions was collected using a 7-item questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 63 subjects, 43(68.3%) were women and 20(31.7%) were men. The overall mean age was 33.53±6.76 years. There were 42(66.7%) subjects using N95 mask; 27(64.3%) women and 15(35.7%) men with mean age 32.38±6.54 years. There were 21(33.3%) subjects wearing surgical masks; 16(76.2%) women and 5(23.8%) men with mean age 35.95±0.76 years. Intergroup comparisons were non-significant for all the markers (p>0.05). Within the N95 mask group, potential of hydrogen and lactate values were significantly different (p<0.05), while in the surgical mask group, potential of hydrogen and partial pressure of oxygen were significantly different (p<0.05). There were 28(66.7%) subjects in the N95 group who had been affected by coronavirus disease-2019 compared to 16(76.2%) in the surgical mask group (p>0.05). Subjects in the N95 mask group had significant impaired cognitive functions compared to the surgical mask group (p<0.05). Conclusion: Impairment in cognitive functions in intensive care unit workers using masks could be explained by the development of intermittent long-term moderate hypoxia.

Preoperative red cell distribution width to lymphocyte ratio as biomarkers for prolonged intensive care unit stay among older patients undergoing cardiac surgery: a retrospective longitudinal study.

Introduction: Our aim was to use the red cell distribution width-lymphocyte ratio (RLR) as a novel biomarker to predict prolonged intensive care unit (ICU) length of stay (LOS) among older patients undergoing cardiovascular surgery. Methods: This longitudinal study included older patients admitted to a tertiary cardiovascular surgery hospital between January 2017 and January 2022. Results: A total of 574 patients were studied, including 83 patients (14.5%) who had prolonged ICU LOS and 471 (85.5%) control subjects. After adjustment for the European System for Cardiac Operative Risk Evaluation 2, the RLR score showed a 10% increased risk of prolonged ICU LOS (odds ratio: 1.10; CI: 1.05-1.16; p = 0.01). Conclusion: Preoperative RLR can be used to predict the risk of long-term intensive care stay in older cardiac surgery patients.

Predictors of Pacemaker-Induced Cardiomyopathy and Importance of Nutritional Status and Prognostic Nutritional Index.

Background: Long-term right ventricular (RV) pacing may cause progressive left ventricular systolic dysfunction, and malnutrition is related to adverse cardiovascular outcomes in patients with heart failure. We aimed to evaluate the relationship between immunonutritional status and the development of pacing-induced cardiomyopathy (PICMP). Methods: This study included 434 patients who underwent permanent pacemaker (PPM) implantation and had preserved left ventricular ejection fraction (LVEF) of > 40%. At six months of follow-up, the patients with LVEF < 40% were defined as having PICMP. Baseline prognostic nutritional index (PNI) was calculated based on serum albumin and lymphocyte count. Results: Overall, 16.5% of the our study patients developed PICMP. The PICMP group had more males (p = 0.013), lower baseline LVEF values (p = 0.014) and lower baseline PNI levels (p < 0.001). RV pacing ratios and paced QRS intervals were higher in the PICMP group (p < 0.001 for both), but the types of implanted pacemakers were similar for all patients (p = 0.709). According to regression analyses, baseline LVEF (p = 0.020), PNI (p < 0.001), C-reactive protein level (p = 0.012), RV pacing ratio (p < 0.001) and paced QRS interval (p = 0.001) were independent predictors of PICMP development. A cut-off PNI value ≤ 43.2 at the time of PPM implantation could predict PICMP development with a sensitivity of 85.5% and specificity of 86.7% (p < 0.001). Conclusions: Identifying poor nutritional status using the PNI may be an important concept to predict PICMP development, and optimizing nutritional status might help to reduce adverse outcomes in these patients.

SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta.

BACKGROUND: There is no study about the relationship between the complexity of coronary artery disease (SYNTAX SCORE; SS), and coronary artery calcium (CAC) score, accompanied with aortic calcium score (ACS) levels. The objective of this study was to investigate the relationship between the preoperative SS and CAC scores accompanying ACS in isolated CABG patients and their postoperative clinical results. METHODS: This study included 130 consecutive CABG patients. The mean age of the patients was 62.3 ± 8.62 years (range: 47-84 years). SS was measured using coronary angiography by an experienced cardiologist. We investigated the ACS accompanied with CAC scores using a multidetector computed tomography (MDCT) in the same session, preoperatively. Measurements of the CAC score and ACS were measured by an experienced radiologist, who was unaware of the study in the same session. In order to investigate aortic wall pathology in patients with positive aortic calcification, we provided aortic tissue samples prior to the proximal anastomosis of bypass grafts using No:11 scalpel. RESULTS: Overall median SS was 39 ± 7.2 (range: 15-41). CAC score was zero in 34 patients (26.1%). For the patients with a CAC score of zero, the median SS was 32 ± 9.4. There was no evidence of aortic calcification or plaque formation in 62 patients (47.6%). In these patients, the median SS was 35.6 ± 11.3. No significant difference was found when both groups were compared and for those patients with a calcific score of zero (P = .85). The median CAC score and ACS were 238 ± 122 AU (range: 0-1238 AU) and 112 ± 40 AU (range: 0-730 AU), respectively (P = .0033). For patients with a CAC score and ACS ≥400 AU, the mean SYNTAX score was ≥ 37. SS was correlated with CAC score (R:0.585; P < .0001). SYNTAX was correlated with ACS (R:0.557; P < .001). In multivariate analysis of SS (OR 1.053, 95% CI: 1.003-1.106, P = .039), gender (OR 0.189, 95% CI: 0.053-0.678, P = 0.011), age (OR 1.454, 95% CI: 1.256-1.632, P = .012), and diabetes mellitus (OR 0.341, 95% CI: 1.006-1.124, P = .014) were independent predictors for CAC score and aortic calcification. CONCLUSIONS: CAC score and ACS are strongly correlated with the complexity of coronary arteries in CABG patients. The total CAC score (≥ 400 AU) was independently associated with the degree of SS (>37). To prevent MACCE and mortality in CABG patients, we suggest the measurement of CAC score accompanied with ACS using MDCT as a non-invasive method. Highlight points: • Atherosclerotic plaque formation in aorta and coronary arteries are the main risk factors for stroke and infarction in CABG operations. •SYNTAX score value and aortic atherosclerosis levels are directly correlated. •SYNTAX score may predict the complications due to atherosclerosis during heart surgery.

A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery?

INTRODUCTION: Left internal mammary artery (LIMA) grafts should be used in patients undergoing CABG. No other procedure results in patency equivalent to that of the left anterior descending coronary artery (LAD)-LIMA bypass graft. The CHA2DS2-Vasc-HS scoring system can be used to successfully predict CAD severity in stable CAD patients. We aimed to investigate the relationship between LIMA flow and the CHA2DS2-Vasc-HS score. METHODS: A total of 684 patients, who underwent CABG surgery, were included in this study. Previous history of bypass surgery, emergency operations, patients with Leriche syndrome and patients with severe obstructive pulmonary and subclavian artery disease were excluded from our study. Patients with a LIMA flow that was suitable for bypass grafting, as determined during the intraoperative evaluation, were included in the low LIMA flow group, and the CHA2DS2-Vasc-HS score was calculated for all patients. RESULTS: Patients in the low LIMA flow group (Group 1) were older. The CHA2DS2-Vasc-HS score (P < 0.001), presence of mild or moderate COPD (P = 0.022), number of severely diseased vessels (P = 0.036), and BMI (P < 0.001) were independent predictors of poor LIMA flow. The cutoff value of the CHA2DS2-VASc-HS score for the prediction of poor LIMA flow was >5.5, with a sensitivity of 92.9% and specificity of 83.4% (AUC: 0.938, 95% Cl: 0.906 - 0.970, P < 0.001). CONCLUSION: A preoperative high CHA2DS2-Vasc-HS score can be used to predict low intraoperative LIMA flow. The CHA2DS2-Vasc-HS score is an easy-to-use and reliable estimation method and can be used as an additional preoperative of LIMA flow in patients undergoing CABG due to severe CAD.

Can Pre-Operative HbA1c Values in Coronary Surgery be a Predictor of Mortality?

OBJECTIVE: One of the most frequently studied parameters in terms of outcome estimation in cardiac surgery is HbA1c. Several studies in literature suggest that high HbA1c value increases mortality and morbidity, but there is no relation between them. The primary aim of the present study is to investigate whether HbA1c value in diabetic patients undergoing coronary bypass graft surgery is an independent predictor for post-operative mortality and morbidity, and our secondary goal was to determine independent risk factors that cause mortality and morbidity in the same patient population. METHODS: 380 diabetic patients diagnosed with diabetes who underwent coronary surgery with cardiopulmonary bypass in Mersin State hospital between July 2014 to December 2016 after the approval of the Mersin University Faculty of medicine ethics committee were included in this retrospective, observational, and cross-sectional study. Patient demographic and perioperative information were obtained from the electronic information operating system and from anesthesia-intensive care follow-up forms. The HbA1c threshold was accepted as 7%, which was reported to be more appropriate for evaluating high-risk groups. RESULTS: Three hundred and fifty-four patients with complete access to the data were included in the study. The mean age of the patients was 60.8±9.4 years. 37% of the patients (131 patients) were female. The number of patients with HbA1c≥7 was 194 (54,8%) in the entire patient population. In this study, high HbA1c (≥7) values in diabetic patients undergoing isolated coronary bypass graft surgery were not found to be independent predictors of post-operative mortality and morbidity. Mortality was seen in 28 patients (7.9%). Ejection fraction (EF) was found to be an independent predictor factor for pre-operative factors in logistic regression models constructed according to mortality predictors (OR:0.94; 95% CI: 0.90-0.99; p=0.016). Complications were seen in 50 patients (14.1%). In the models formed from the point of view of the complication predicators, only EF was found to be independent predictor (OR:0.95; 95% CI: 0.92-0.98; p=0.004). It was found that HbA1c was not predictive in all models for mortality and complication (p>0.05). CONCLUSION: There are reports in the literature that mortality increases 4-fold when HbA1c value is higher than 8.6% in coronary surgery. However, there is a view that HbA1c alone cannot predict mortality in coronary surgery if diabetes associated factors are excluded. In this study, high HbA1c (≥7) values in diabetic patients undergoing isolated coronary bypass graft surgery were not found to be independent predictors of post-operative mortality and morbidity. Pre-operative low ejection fraction was found as an independent risk factor for post-operative mortality and morbidity in the general patient population.

Postperfusion Syndrome in Cadaveric Liver Transplantations: A Retrospective Study.

OBJECTIVE: To evaluate the factors that affects the postperfusion syndrome in cadaveric liver transplantations and the effect of the postperfusion syndrome on discharge from the hospital. METHODS: Patients who underwent cadaveric liver transplantations between 2007 and 2013 were scanned retrospectively. Intraoperative anaesthesia records, intensive care unit follow-up forms and discharge reports were examined from patient files. Overall, 43 patients having complete data were included in the study. The postperfusion syndrome is defined as asystoli or a decrease in mean arterial pressure of more than 30%, which occurred in the first 5 min of reperfusion and continued for 1 min. Patients were divided into two groups: those who had the postperfusion syndrome and those who did not. RESULTS: The number of patients who had the postperfusion syndrome was 25 of 43 (58.1%). The MELD score of patients without the postperfusion syndrome was calculated as 16.9±3.2 and that of patients with the postperfusion syndrome was 19.7±3.6. A statistically significant relationship was detected between the postperfusion syndrome occurrence and a high MELD score (p=0.013). The diastolic blood pressure just before reperfusion was statistically lower in the group with the postperfusion syndrome than in the other group (p=0.023, 50±8 vs. 58±11). According to the logistic regression analysis, the MELD score and the decrease in diastolic blood pressure before reperfusion were defined as independent predictive factors. CONCLUSION: According to the study, the ratio for having the postperfusion syndrome was found to be 58.1%. The independent predictor factors affecting the postperfusion syndrome were detected as the MELD score and the decrease in diastolic blood pressure before reperfusion. The postperfusion syndrome during orthotropic liver transplantation is an important issue for anaesthesiologists. The awareness of the related factors with the postperfusion syndrome may help in the development of various preventive strategies.

Hematological predictors and clinical outcomes in cardiac surgery.

PURPOSE: The present study was to investigate if five values that are part of the hemogram analysis routinely checked before heart surgeries can be used as a high-quality, quick, low-cost, and easy-to-use outcome predictor. METHODS: This investigation was a retrospective, observational, cross-sectional study. Univariate and multivariate logistic regression was used to identify independent predictors for combined adverse events. We enrolled 1500 consecutive patients who underwent elective, on-pump, open-heart surgery from 2011 to 2014. Preoperative hemogram evaluation, red cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were recorded. We classified combined adverse events (CAE) as (1) myocardial infarction, (2) cardiac reoperation, (3) prolonged mechanical ventilation, (4) prolonged hospital stay, (5) rehospitalization, or (6) mortality. RESULTS: It was found that several parameters obtained as part of the hemogram, namely RDW, MPV, PLR, and NLR, can predict, individually or in combinations, the outcomes in open-heart surgery patients. It was found that the prediction success of NLR (4.8 fold) was higher compared to RDW (1.8 fold) and MPV (1.5 fold). When the prediction success of the combined parameters was investigated, the NLR-RDW (4.7 fold) pair was found higher in the prediction of CAE occurrence. The predictive success of the triple combination of NLR-MPV-RDW (5.5 fold) was higher than other combinations. CONCLUSIONS: The triple combination of parameters obtained as part of the hemogram, NLR-RDW-MPV, indicated a much more predictive power than two parameters coupled. This combination of three parameters, NLR-RDW-MPV, is to be considered as a sensitive, high-quality, low-cost outcome prediction marker for cardiac surgery patients that is less time consuming and easy to use.

10 cm H2O PEEP application in laparoscopic surgery and cerebral oxygenation: a comparative study with INVOS and FORESIGHT.

INTRODUCTION: In the present study, changes in hemodynamic parameters and cerebral oxygen saturation (rSO2) associated with 10 cm H2O PEEP application were investigated, which is assumed beneficial for the respiratory functions and oxygenation during laparoscopic cholecystectomy (LC) applied at 30° head-up left side position. Data gathered via two devices, namely INVOS and FORESIGHT, were compared. METHODS: After both the ethics committee approval from the hospital and patients' written consents were obtained, patients undergoing elective laparoscopic surgery (only ASA I-II) were randomly divided into two groups (Clinical trials protocol NCT02071550). Sensors of INVOS and FORESIGHT devices were placed on the right side at the forehead region. In total, 11 evaluation periods were formed, namely pre-induction (1st period), post-induction (2nd period), abdominal insufflation outset (3rd period), post-insufflation at 5-min intervals (4th, 5th, 6th, 7th, and 8th period), at the end of insufflation (9th period), at the end of operation (10th period), and at the end of anesthesia (11th period). While one of the groups did not receive PEEP (ZEEP group), the other group received 10 cm H2O along with abdominal insufflation (PEEP group). Demographic data, hemodynamic values, and rSO2 values were recorded for both groups at all 11 periods. RESULTS: A total of 44 patients in two groups, each group containing 22 individuals, were included in the study. Systolic, diastolic, and mean arterial pressures, etCO2 and SO2 values, and demographic data were found to be similar in both groups. Heart rate was observed to be higher in the PEEP group starting with the PEEP administration. INVOS rSO2 values were found similar in both groups. However, FORESIGHT rSO2 values were found to be higher in the PEEP group compared to the ZEEP group. No patient had cerebral desaturation in both groups throughout the study. DISCUSSION: Application of PEEP with 10 cm H2O during abdominal insufflation could increase the rSO2 value and heart rate in patients undergoing laparoscopic cholecystectomy. However, all changes observed were within normal limits. FORESIGHT device yielded more compatible results with hemodynamic data compared to INVOS.

Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP.

INTRODUCTION: Using single anesthetic agent in endoscopic retrograde cholangiopancreatography (ERCP) may lead to inadequate analgesia and sedation. To achieve the adequate analgesia and sedation the single anesthetic agent doses must be increased which causes undesirable side effects. For avoiding high doses of single anesthetic agent nowadays combination with sedative agents is mostly a choice for analgesia and sedation for ERCP. AIM: The aim of this study is to investigate the effects of propofol alone, propofol + remifentanil, and propofol + fentanyl combinations on the total dose of propofol to be administered during ERCP and on the pain scores after the process. MATERIALS AND METHOD: This randomized study was performed with 90 patients (ASA I-II-III) ranging between 18 and 70 years of age who underwent sedation/analgesia for elective ERCP. The patients were administered only propofol (1.5 mg/kg) in Group Ι, remifentanil (0.05 µg/kg) + propofol (1.5 mg/kg) combination in Group II, and fentanyl (1 µg/kg) + propofol (1.5 mg/kg) combination in Group III. All the patients' sedation levels were assessed with the Ramsey Sedation Scale (RSS). Their recovery was assessed with the Aldrete and Numerical Rating Scale Score (NRS) at 10 min intervals. RESULTS: The total doses of propofol administered to the patients in the three groups in this study were as follows: 375 mg in Group I, 150 mg in Group II, and 245 mg in Group III. CONCLUSION: It was observed that, in the patients undergoing ERCP, administration of propofol in combination with an opioid provided effective and reliable sedation, reduced the total dose of propofol, increased the practitioner satisfaction, decreased the pain level, and provided hemodynamic stability compared to the administration of propofol alone.

Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery.

Transient neurologic dysfunction is common after aortic surgery. Major causes of postoperative complications followed by cardiac surgery are due to hypoperfusion states such as selective cerebral perfusion, embolic debris during cardiopulmonary bypass and ulcerated plaque emboli originated from carotid arteries. Neurologic complications prolong periods of intensive care unit and hospital stay, worsens quality of life and unfortunately they are an important cause of morbidity. Anaesthesia during a carotid and aortic surgery constitutes of providing adequate brain perfusion pressure, attenuating cerebral metabolism by anaesthetic agents and monitoring the cerebral metabolic supply and demand relationship during the intraoperative period. We present a monitoring approach with an intraoperative 16-channel electroencephalography and bilateral near infrared spectroscopy during redo aneurysm of the sinus of Valsalva surgery.

The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations.

OBJECTIVE: The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. METHODS: Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete's Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. RESULTS: Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. CONCLUSION: In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.

Investigation of the effects of preoperative hydration on the postoperative nausea and vomiting.

INTRODUCTION: Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy operations still continue to be a serious problem. Intravenous fluid administration has been shown to reduce PONV. Some patients have higher risk for PONV described by APFEL score. In this study, our aim was to determine the effects of preoperative intravenous hydration on postoperative nausea and vomiting in high Apfel scored patients undergoing laparoscopic cholecystectomy surgery. PATIENTS AND METHODS: This study is performed with 50 female patients who had APFEL score 3-4 after ethics committee approval and informed consent was taken from patients. The patients were divided into 2 groups: group 1 (P1): propofol + preoperative hydration and group 2 (P2): propofol + no preoperative hydration. RESULTS: When the total nausea VAS scores of groups P1 and P2 to which hydration was given or not given were compared, a statistically significant difference was detected at 8th and 12th hours (P = 0.001 and P = 0.041). It was observed that in group P1, which was given hydration, the nausea VAS score was lower. When the total number of patients who had nausea and vomiting in P1 and P2, more patients suffered nausea in P2 group. DISCUSSION: Preoperative hydration may be effective in high Apfel scored patients to prevent postoperative nausea.

The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass--randomized trial.

BACKGROUND: Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac surgery. These complications are thought to be caused by embolisms and cerebral hypoxia. Thus, continuous neuromonitoring is essential during cardiac surgery due to cerebral oxygen desaturation during different periods. Near-infrared spectrophotometry (NIRS), a non-invasive method, appears to offer many advantages for monitoring cerebral oxygenation and hemodynamics. Desaturation of cerebral oxygen may occur at the beginning of cardiopulmonary bypass (CPB) or during the low perfusion and rewarming stages if not corrected. OBJECTIVES: This study was designed to assess the effects of sevoflurane on cerebral protection during CPB. MATERIAL AND METHODS: Eighty patients were divided into two groups. Anesthesia was maintained either with fentanyl and midazolam (total intravenous anesthesia, TIVA) or with one minimum alveolar concentration of sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute decrease in saturation of 20% from baseline cerebral saturation. When desaturation occurred, PaCO2, hematocrit and PaO2 levels were checked and corrected. If desaturation continued, anesthetic depth was increased to reserve saturation with 50-100 mg of propofol. NIRS values and hemodynamics were recorded at predetermined time intervals. RESULTS: Cerebral oxygen saturation values on the right side were higher in the sevoflurane group than in the TIVA group. The values on the left side were higher in the sevoflurane group than in the TIVA group, and meaningful differences were seen at the lowest temperature and at 36°C. CONCLUSIONS: Oxygen saturation was higher in the sevoflurane group than in the TIVA group. Thus, the effect of sevoflurane was useful for maintaining cerebral oxygen saturation during CBP.

Monitoring Cardiac Output and Transesophageal Echocardiography during Removal of a Ventricular Assist Device.

A ventricular assist device (VAD) is a mechanical pump used to support heart function and blood flow in patients with poor heart functions. For selected patients who are too ill to wait for a heart transplant or are not eligible for a heart transplant because of age or other medical problems, ventricular assist devices offer life-saving therapy. This device has also become a life-saving approach for patients with acute viral myocarditis. Following the acute illness phase, when heart function has improved, the VAD is carefully removed. It is very important to continuously monitor myocardial functions during this period. In this paper, we present a patient who underwent cardiac output and transesophageal echocardiography monitoring during VAD removal.

Obesity and postoperative early complications in open heart surgery.

PURPOSE: We investigated the distribution of early clinical outcomes among normal, obese, and morbidly obese patients undergoing open heart surgery. METHODS: Medical records of 1,000 patients undergoing open heart surgery since February 2011 at our hospital were investigated retrospectively after permission was obtained from the Council of Education Planning of the hospital. The comorbidities and perioperative and discharge data were analyzed for 279 patients with a body mass index (BMI) score between 18 and <30 [non-obese reference group (NRG, n = 279)]; 166 patients with BMI between 30 and <35 [obese group (OG, n = 166); and 192 seriously obese patients with BMI ≥35 [extreme obese group (EOG, n = 192)]. Distribution of the patients according to BMI scores was found to represent the BMI distribution of the Turkish population. RESULTS: Pulmonary and infective complications were significantly higher in EOG patients compared to NRG based on crude confidence interval. Based on adjusted multiple logistic regression analysis, by adjusting the effects of age, sex, comorbidities (diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease), and smoking, the incidence of pulmonary and gastrointestinal complications in EOG was higher compared to NRG. Discharge with morbidity was significantly higher in OG and EOG compared to NRG. CONCLUSIONS: We found that obesity does not increase short-term mortality for open heart surgery; however, it increases the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity.