The Department of Anesthesiology and the Department of Cardiothoracic Surgery at Weill Cornell Medicine teamed up to utilize big data sources to tackle tough questions related to the care of patients after pulmonary lobectomies. The first in a series of three articles was published in The Journal of Thoracic and Cardiovascular Surgery.
Giambrone, GP, Wu, X, Gaber-Baylis, LK, Paul, S, Bhat, AU, Zabih, R, Altorki, NK, Fleischut, PM*, Stiles, BM*. Incidence and Implications of Postoperative Supraventricular Tachycardia Following Pulmonary Lobectomy. The Journal of Thoracic and Cardiovascular Surgery. 2016;151(4):982-9.
From J Thorac Cardiovasc Surg
Using the State Inpatient Database, from the Healthcare Cost and Utilization Project, we reviewed lobectomies performed (2009-2011) in California, Florida, and New York, to determine POSVT incidence. Patients were grouped by presence or absence of POSVT, with or without other complications. Stroke rates were analyzed independently from other complications. Multivariable regression analysis was used to determine factors associated with POSVT.
Among 20,695 lobectomies performed, 2449 (11.8%) patients had POSVT, including 1116 (5.4%) with isolated POSVT and 1333 (6.4%) with POSVT with other complications. Clinical predictors of POSVT included age ≥75 years, male gender, white race, chronic obstructive pulmonary disease, congestive heart failure, thoracotomy surgical approach, and pulmonary complications. POSVT was associated with an increase of: stroke (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.03-2.94); in-hospital death (OR 1.85; 95% CI 1.45-2.35); LOS (OR 1.33; 95% CI 1.29-1.37); and readmission (OR 1.29; 95% CI 1.04-1.60). The stroke rate was <1% in patients who had isolated POSVT, and 1.5% in patients with POSVT with other complications. Patients with isolated POSVT had increased readmission and LOS, and a marginal increase in stroke rate, compared with patients with an uncomplicated course.
POSVT is common in patients undergoing pulmonary lobectomy and is associated with adverse outcomes. Comparative studies are needed to determine whether strict adherence to recently published guidelines will decrease the rate of stroke, readmission, and death after POSVT in thoracic surgical patients."