Thorac Cardiovasc Surg 2016; 64(07): 575-580
DOI: 10.1055/s-0035-1566234
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Patients under Psychiatric Medication Undergoing Cardiac Surgery Have a Higher Risk for Adverse Events

Sandra Brunner
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Claudius Diez
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Bernhard Flörchinger
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Philipp Kolat
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christof Schmid
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Daniele Camboni
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

20 February 2015

18 September 2015

Publication Date:
30 October 2015 (online)

Abstract

Objective The percentage of patients undergoing cardiac surgery under some sort of psychiatric medication (PM) is not negligible. Thus, this study aimed to evaluate a possible impact of preoperative PM on the outcome after cardiac surgery.

Methods A matched case–control study was conducted by including all patients who underwent myocardial revascularization and/or surgical valve operation in our institution from December 2008 till February 2011 by chart review and institutional quality assurance database (QS) analysis.

Results Out of 1,949 patients included, 184 patients (9%) were identified with PM medication (group A). A control group matched for logistic EuroSCORE II, ejection fraction and age was generated (group C). Patients with PM were in mean significantly longer on the intensive care unit (A: 4.94 days; 95% confidence interval (CI), 3.9–5.9 days vs. C: 3.24 days; CI, 2.84–3.64 days; p = 0.003), had longer mechanical ventilation times (A: 36.70 hours; CI, 19.81–53.59 hours vs. C: 20.14 hours; CI, 14.61–25.68 hours; p = 0.258), and significantly more episodes of respiratory insufficiencies (A: 31 episodes [17%] vs. C: 17 episodes [9%]; p = 0.002). Regression analysis revealed preoperative PM as a significant risk factor for respiratory insufficiency (odds ratio: 1.99, CI: 1.0–3.74; p = 0.04). Chest tube drainage (A: 690 mL, CI: 571–808 mL vs. C: 690 mL; CI: 496–884 mL, p = 0.53) and the total amount of red blood cell transfusion units were similar (A: 1.69 units; CI: 1.21–2.18 units vs. C: 1.50 units; CI: 1.04–1.96 units; p = 0.37). Sternal dehiscence requiring sternal refixation was significantly more frequent in A (12 patients [7%] vs. C: 2 patients [1%]; odds ratio: 6.3, CI: 1.4–28.7; p = 0.01). The 30-day mortality was similar in both groups (A: 6 patients [3%] vs. C: 4 patients [2%]; odds ratio: 1.5; CI: 0.4–5.4; p = 0.5); however, the 100-day mortality was near significantly higher in group A (A: 14 patients (8%) vs. C: 6 patients (3%); odds ratio: 2.4, CI: 0.9–6.5, p = 0.057).

Conclusion Patients with preoperative PM developed complications more frequently compared with a matched control group. The underlying multifactorial mechanisms remain unclear. Patients under PM need to be identified and particular care including optimal pre- and postoperative psychiatric assistance is recommended.

Note

This article was presented at the 42th Annual Meeting of the DGTHG in Freiburg as an oral presentation.