Clinical Outcomes in Patients with Phosphate Abnormalities After Cardiac Surgery: A Retrospective Cohort Study.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-10-09 DOI:10.1213/ANE.0000000000007229
Dominik T Steck, Nicki Mostofi, Kei Togashi, Rui Li, David Wu, Lauren Wells, Christine T Fong, Kyle Tillinghast, Vikas N O'Reilly-Shah, Srdjan Jelacic
{"title":"Clinical Outcomes in Patients with Phosphate Abnormalities After Cardiac Surgery: A Retrospective Cohort Study.","authors":"Dominik T Steck, Nicki Mostofi, Kei Togashi, Rui Li, David Wu, Lauren Wells, Christine T Fong, Kyle Tillinghast, Vikas N O'Reilly-Shah, Srdjan Jelacic","doi":"10.1213/ANE.0000000000007229","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The clinical significance and incidence of phosphate abnormalities in cardiac surgery have not been investigated extensively. We hypothesize that phosphate abnormalities are associated with a longer time to tracheal extubation.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study in patients who underwent nontransplant cardiac surgery with cardiopulmonary bypass between August 2009 and December 2020. Serum phosphate levels were measured within 6 hours of arrival to the intensive care unit (ICU). Select clinical outcomes were extracted from an intramural database: time to tracheal extubation, hospital length of stay, and in-hospital mortality. The lactate level within 6 hours of arrival to the ICU was extracted as well.</p><p><strong>Results: </strong>A total of 2659 patients were included. There were 502 (18.9%) patients who were found to be hypophosphatemic (phosphate <2.5 mg/dL), 1905 (71.6%) had normal phosphate levels (phosphate 2.5-4.5 mg/dL), and 252 (9.5%) were hyperphosphatemic (phosphate >4.5 mg/dL). Hyperphosphatemia was associated with 26% longer time to tracheal extubation (incident rate ratio, 1.26, 95% confidence interval [CI], 10%, 44%, P = .001), 37% longer hospital length of stay (acceleration factor = 0.63, 95% CI, -43% to -30%); P < .001), and increased in-hospital mortality (odds ratio, 4.0; 95% CI, 2.3-7.1; P < .001) when compared to patients with normal phosphate levels. These associations were not found for hypophosphatemia.</p><p><strong>Conclusions: </strong>Hyperphosphatemia in the immediate postoperative period after cardiac surgery is associated with adverse clinical outcomes. Future studies will need to investigate if actively correcting the phosphate level has an impact on clinical outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesia and analgesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1213/ANE.0000000000007229","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The clinical significance and incidence of phosphate abnormalities in cardiac surgery have not been investigated extensively. We hypothesize that phosphate abnormalities are associated with a longer time to tracheal extubation.

Methods: This was a single-center, retrospective cohort study in patients who underwent nontransplant cardiac surgery with cardiopulmonary bypass between August 2009 and December 2020. Serum phosphate levels were measured within 6 hours of arrival to the intensive care unit (ICU). Select clinical outcomes were extracted from an intramural database: time to tracheal extubation, hospital length of stay, and in-hospital mortality. The lactate level within 6 hours of arrival to the ICU was extracted as well.

Results: A total of 2659 patients were included. There were 502 (18.9%) patients who were found to be hypophosphatemic (phosphate <2.5 mg/dL), 1905 (71.6%) had normal phosphate levels (phosphate 2.5-4.5 mg/dL), and 252 (9.5%) were hyperphosphatemic (phosphate >4.5 mg/dL). Hyperphosphatemia was associated with 26% longer time to tracheal extubation (incident rate ratio, 1.26, 95% confidence interval [CI], 10%, 44%, P = .001), 37% longer hospital length of stay (acceleration factor = 0.63, 95% CI, -43% to -30%); P < .001), and increased in-hospital mortality (odds ratio, 4.0; 95% CI, 2.3-7.1; P < .001) when compared to patients with normal phosphate levels. These associations were not found for hypophosphatemia.

Conclusions: Hyperphosphatemia in the immediate postoperative period after cardiac surgery is associated with adverse clinical outcomes. Future studies will need to investigate if actively correcting the phosphate level has an impact on clinical outcomes.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
心脏手术后磷酸盐异常患者的临床疗效:回顾性队列研究
背景:尚未对心脏手术中磷酸盐异常的临床意义和发生率进行广泛研究。我们假设磷酸盐异常与气管拔管时间延长有关:这是一项单中心、回顾性队列研究,研究对象为 2009 年 8 月至 2020 年 12 月期间接受心肺旁路非移植心脏手术的患者。研究人员在患者到达重症监护室(ICU)6小时内测量了血清磷酸盐水平。从校内数据库中提取了部分临床结果:气管拔管时间、住院时间和院内死亡率。此外,还提取了抵达重症监护室 6 小时内的乳酸水平:结果:共纳入 2659 名患者。结果:共纳入 2659 例患者,其中 502 例(18.9%)患者被发现患有低磷血症(磷酸盐 4.5 mg/dL)。与磷酸盐水平正常的患者相比,高磷酸盐血症导致气管插管时间延长 26%(事故率比为 1.26,95% 置信区间 [CI],10%,44%,P = .001),住院时间延长 37%(加速因子 = 0.63,95% CI,-43% 至 -30%);P < .001),院内死亡率增加(几率比为 4.0;95% CI,2.3-7.1;P < .001)。结论:结论:心脏手术后即刻出现的高磷血症与不良临床结果有关。未来的研究将需要调查积极纠正磷酸盐水平是否会对临床结果产生影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
期刊最新文献
A Little Blue Butterfly. A Paradigm for Shared Decision-Making in Pediatric Anesthesia Practice for Children with Autism for the Generalist Clinician. Association Between Two Muscle-Related Parameters and Postoperative Complications in Patients Undergoing Colorectal Tumor Resection Surgery. Cannabinoids and General Anesthetics: Revisiting Molecular Mechanisms of Their Pharmacological Interactions. Consensus Statement on Pain Management for Pregnant Patients with Opioid-Use Disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1