Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis

Fridtjof Schiefenhövel; Akira-Sebastian Poncette; Edward M Boyle; Christian von Heymann; Mario Menk; Gerald Vorderwülbecke; Herko Grubitzsch; Sascha Treskatsch; Felix Balzer

doi:10.1186/s13019-022-02050-y

Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis

J Cardiothorac Surg. 2022 Dec 7;17(1):298. doi: 10.1186/s13019-022-02050-y.

Authors

Fridtjof Schiefenhövel^#^{1

2

3}, Akira-Sebastian Poncette^#^{4

1}, Edward M Boyle⁵, Christian von Heymann⁶, Mario Menk^{4

1}, Gerald Vorderwülbecke⁴, Herko Grubitzsch⁷, Sascha Treskatsch^#⁸, Felix Balzer^#¹

Affiliations

¹ Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany.
² Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany.
³ Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Institute of Artificial Intelligence and Informatics in Medicine, Munich, Germany.
⁴ Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany.
⁵ Department of Cardiothoracic Surgery, St. Charles Medical Center, Bend, OR, USA.
⁶ Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
⁷ Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
⁸ Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, 12203, Berlin, Germany. sascha.treskatsch@charite.de.

^# Contributed equally.

Abstract

Background: Pleural effusions commonly occur in patients recovering from cardiac surgery; however, the impact on outcomes is not well characterized. The purpose of this study is to characterize the clinical outcomes of cardiac surgery patients with pleural effusion.

Methods: All patients undergoing cardiac surgery between 2006 and 2019 at a tertiary care university hospital were included in this observational, cross-sectional analysis using propensity matching.

Results: Of 11,037 patients that underwent cardiac surgery during the study period, 6461 (58.5%) had no pleural effusion (Group 0), 3322 (30.1%) had pleural effusion only (Group 1), and 1254 (11.4%) required at least one secondary drainage procedure after the index operation (Group 2). After propensity matching, the mortality of patients who underwent secondary drainage procedures was 6.1% higher than in Group 1 (p < 0.001). Intensive care unit (ICU) stay was longer for those with pleural effusions (18 [IQR 9-32] days in Group 2, 10 [IQR 6-17] days for Group 1, and 7 [IQR 4-11] days for Group 0, p < 0.001). Patients with pleural effusions had a higher incidence of hemodialysis (246 [20.0%] in Group 2, 137 [11.1%] in Group 1, 98 [7.98%] in Group 0), and a longer ventilation time in the ICU (57 [IQR 21.0-224.0] hours in Group 2, 25.0 [IQR 14.0-58.0] hours in Group 1, 16.0 [IQR 10.0-29.0] hours in Group 0).

Conclusion: Pleural effusions, especially those that require a secondary drainage procedure during recovery, are associated with significantly worse outcomes including increased mortality, longer length of stay, and higher complication rates. These insights may be of great interest to scientists, clinicians, and industry leaders alike to foster research into innovative methods for preventing and treating pleural effusions with the aim of improving outcomes for patients recovering from cardiac surgery.

Trial registration: ClinicalTrials.gov NCT03409055.

Keywords: Cardiac surgery; Intensive care medicine; Intensive care unit; Mortality; Outcomes; Pleural effusions; Postoperative.

Publication types

Observational Study

MeSH terms

Cardiac Surgical Procedures* / adverse effects
Cross-Sectional Studies
Humans
Pleural Effusion*
Postoperative Period

Associated data

ClinicalTrials.gov/NCT03409055