Effects of left ventricular ejection fraction on morbidity and mortality in major abdominal surgery
International Journal of Clinical and Experimental Medicine, cilt.10, sa.12, ss.16632-16638, 2017 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 10 Sayı: 12
- Basım Tarihi: 2017
- Dergi Adı: International Journal of Clinical and Experimental Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.16632-16638
- Anahtar Kelimeler: Non-cardiac surgery, low ejection fraction, mortality, morbidity, abdominal surgery
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Our aim in this study was to investigate the effects of Left Ventricular Ejection Fraction (LVEF) on the clinical results of patients who underwent major abdominal procedures due to the malignancies of the gastrointestinal system (GIS). Methods: GIS malignancy procedures, which were electively performed in our clinic between 2013 and 2016, were included in the study. The patients were divided into 4 groups according to their LVEF and were classified as < 30% (Group 1), 30% to 44% (Group 2), 45% to 54% (Group 3) and > 55% (Group 4). Subgroup analysis was performed among the patients with and without peroperative events. In subgroup analysis, independent risk factors were determined using logistic regression analysis for peroperative events in patients undergoing surgery for GI malignancy. Results: A total of 220 patients were covered by the study, including 12 patients in Group 1, 13 patients in Group 2, 25 patients in Group 3, and 170 patients in Group 4. When Group 1 was evaluated, it was seen that 91.7% of the patients had a score of ASA 3 and 58.7% of the patients were on index 4 according to Lee’s Revised Cardiac Risk Index. No significant differences were observed among the groups with regards to preoperative laboratory results, BMI, and pulmonary function test values. No differences were found among the groups regarding diagnoses at the time of admission, surgical procedures performed, duration of operation, and blood transfusion during operation as well. Moreover, there were no significant differences between surgical or non-surgical postoperative complications and the mortality cases within 30 days after surgery. Mortality was seen in three patients and all these patients had an LVEF value higher than 44%. The subgroup multivariate analysis of perioperative complications revealed that diabetes mellitus (DM) (p: 0.017, OR: 2.457, CI: 0.194-0.853), duration of operation over 300 minutes (p: 0.001, OR: 2.68, CI: 0.204-0.682) and older than 65 years (p: 0.007, OR: 2.341, CI: 0.230-0.794) were independent risk factors. Conclusion: When assessed according to LVEF, there was no difference between groups in terms of morbidity and mortality according to Clavian Dindo Classification. We believe that major abdominal procedures for GIS malignancies with low LVEF can be performed with acceptable morbidity and mortality rates at experienced centers.