Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery.

Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. Results: In the "preoperative model" predictors for mortality were advanced age ( p < 0.001), New York Heart Association (NYHA) class ( p < 0.001) and emergent surgery ( p = 0.036); predictors for non-invasive mechanical ventilation were advanced age ( p < 0.001), low ejection fraction ( p = 0.023), higher body mass index ( p < 0.001) and preoperative renal failure ( p = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease ( p = 0.007), preoperative kidney injury ( p < 0.001) and NYHA class ( p = 0.033). In the "surgery model" predictors for mortality were intraoperative inotropes ( p = 0.003) and intraoperative intra-aortic balloon pump ( p < 0.001), which also predicted the incidence of postoperative pulmonary complications. There were no specific variables in the surgery model predicting the use of non-invasive mechanical ventilation. In the "intensive care unit model", predictors for mortality were postoperative kidney injury ( p < 0.001), tracheostomy ( p < 0.001), inotropes ( p = 0.029) and PaO 2 /FiO 2 ratio at discharge ( p = 0.028); predictors for non-invasive mechanical ventilation were kidney injury ( p < 0.001), inotropes ( p < 0.001), blood transfusions ( p < 0.001) and PaO 2 /FiO 2 ratio at the discharge ( p < 0.001). Conclusions: In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.