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A Novel Technique of Continuous Parasternal Ropivacaine Infusion after Cardiac Surgery: Background Study to the PAINLESS Trial
Abstracts
S233
Cardiac Surgery
552
551
Association Between Body Mass Index and Outcomes Following Coronary Artery Bypass Surgery
A Novel Technique of Continuous Parasternal Ropivacaine Infusion after Cardiac Surgery: Background Study to the PAINLESS Trial
R. Harvey 1,∗ , B. Haluska 2 , J. Mundy 1 , P. Peters 1 , A. Wood 1 , R. Griffin 1 , T. Marwick 2 , P. Shah 1
A. Kiat 1,∗ , R. Dignan 2 , V. Gebski 3 , A. Keech 3,4
1 Department
1 University 2 Liverpool
of New South Wales, Randwick, Australia Hospital, Sydney South West AHS, Sydney, Aus-
tralia 3 NHMRC Clinical Trials Centre, University of Sydney, Syney,
Australia Prince Alfred Hospital, Camperdown, Australia
4 Royal
Objectives: The aim of this study was to examine a novel technique of postoperative sternotomy pain control following coronary artery bypass graft surgery (CAGs) and its impact on recovery time and chronic pain from surgery (CPS). This was a retrospective review of a quality assurance project and an observational study about chronic pain in the same population. Methods: A total of 13 patients who underwent surgery at Liverpool Hospital between November 2007 and March 2008 were treated with a PainBuster (I-Flow, Inc.) device for continuous infusion of ropivacaine solution for 4 days through long catheters inserted bilaterally to the sternal wound. Postoperative outcomes of low risk PainBuster patients were retrospectively compared to a historical control (n = 172). Chronic pain outcomes were investigated by follow-up of all PainBuster patients and a propensity matched cohort (n = 13) via questionnaire. The proportion of patients with CPS 2 years after surgery was compared. Results: The proportion of patients with an ICU stay < 48 h was 5/8 (63%) in the PainBuster group and 77/172 (45%; p = 0.33) in the historical control group. The mean time to discharge from ICU was significantly less in the low risk PainBuster group (38 ± 27 versus 65 ± 53 h; p = 0.01). Chest wound chronic pain appeared slightly less frequent amongst PainBuster patients (1/7 patients or 14%) than amongst propensity matched control patients (5/11 patients or 45%, p = 0.23). Conclusions: A non-significantly greater proportion of patients receiving the PainBuster local anaesthetic intervention were discharged from ICU in less than 48 h. There was a shorter the time to ICU discharge and proportion of patients with chronic pain in patients treated with local anaesthetic compared to the matched control groups was non-significantly lower. A large, randomised controlled trial is underway to determine the impact of this technique on these important outcomes more reliably. doi:10.1016/j.hlc.2010.06.563
of Cardiothoracic Surgery, Princess Alexandra Hospital, Australia 2 Department of Medicine, University of Queensland, Australia Background: Several studies have shown disparate findings regarding body mass index (BMI) and outcomes after CABG. We sought whether BMI and other clinical variables predicted morbidity and mortality after primary CABG. Methods: Data on 4425 pts (3510 [79%] men; age 64 ± 9.8) were prospectively collected from 1998 to 2009. Patients were divided into underweight [UW, BMI < 20, 69 (1.6%)], normal weight [NW, BMI 20–29, 2878 (65%)], obese [OB, BMI 30–39, 1412 (32%)] and morbidly obese [MO, BMI ≥ 40, 66 (1.4%)]. Mean BMI was 28 ± 4.5. Multiple logistic regression was used for correlates of 30-day outcome of the entire group. Cox regression was used for predictors of late outcome in UW and MO. Results: There were 45 (1%) 30-day mortality and 234 (5%) 30-day morbidity. Mean follow-up was 44 ± 34 months. 10/134 (7.5%) late deaths in UW and MO. UW were significantly older (67 ± 10) and MO were significantly younger (59 ± 9) than the others (p < 0.0001). Independent correlates of 30-day morbidity were smoking (HR = 0.45; p −0.005), logistic Euroscore (HR = 0.03; p = 0.002), blood (HR = 1.61; p < 0.0001) and blood products (HR = 1.01; p < 0.0001). Correlates of 30-day mortality were logistic Euroscore (HR = 0.11; p < 0.0001) and blood (HR = 1.20; p < 0.0001). The only independent predictor of late death in UW and MO was pre-op arrhythmias (HR 1.84; p = 0.003). BMI was not a predictor of 30-day morbidity (p = 0.06), early death (p = 0.34) or late death (p = 0.18). 1 year, 3 years and 7 years survival were not significantly different [p = 0.14] between UW (97%, 92%, 91%) and MO (98%, 98%, 95%). Conclusion: BMI did not affect short or long-term outcomes after primary CABG. doi:10.1016/j.hlc.2010.06.564 553 Beyond Serum Creatinine: Creatinine Clearance is a Better Predictor of Postoperative Renal Dysfunction, and Outcomes Following Cardiopulmonary Bypass S. Galvin 1,∗ , A. El-Gamel 1,2,∗ 1 Waikato 2 King’s
Hospital, Hamilton, New Zealand College Hospital, London, England, United Kingdom
Introduction: Renal failure after cardiac surgery is a well known risk factor for perioperative morbidity and mortality. Although serum creatinine (sCr) is an accepted marker for renal dysfunction, a number of patients with normal
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
S233
Cardiac Surgery
552
551
Association Between Body Mass Index and Outcomes Following Coronary Artery Bypass Surgery
A Novel Technique of Continuous Parasternal Ropivacaine Infusion after Cardiac Surgery: Background Study to the PAINLESS Trial
R. Harvey 1,∗ , B. Haluska 2 , J. Mundy 1 , P. Peters 1 , A. Wood 1 , R. Griffin 1 , T. Marwick 2 , P. Shah 1
A. Kiat 1,∗ , R. Dignan 2 , V. Gebski 3 , A. Keech 3,4
1 Department
1 University 2 Liverpool
of New South Wales, Randwick, Australia Hospital, Sydney South West AHS, Sydney, Aus-
tralia 3 NHMRC Clinical Trials Centre, University of Sydney, Syney,
Australia Prince Alfred Hospital, Camperdown, Australia
4 Royal
Objectives: The aim of this study was to examine a novel technique of postoperative sternotomy pain control following coronary artery bypass graft surgery (CAGs) and its impact on recovery time and chronic pain from surgery (CPS). This was a retrospective review of a quality assurance project and an observational study about chronic pain in the same population. Methods: A total of 13 patients who underwent surgery at Liverpool Hospital between November 2007 and March 2008 were treated with a PainBuster (I-Flow, Inc.) device for continuous infusion of ropivacaine solution for 4 days through long catheters inserted bilaterally to the sternal wound. Postoperative outcomes of low risk PainBuster patients were retrospectively compared to a historical control (n = 172). Chronic pain outcomes were investigated by follow-up of all PainBuster patients and a propensity matched cohort (n = 13) via questionnaire. The proportion of patients with CPS 2 years after surgery was compared. Results: The proportion of patients with an ICU stay < 48 h was 5/8 (63%) in the PainBuster group and 77/172 (45%; p = 0.33) in the historical control group. The mean time to discharge from ICU was significantly less in the low risk PainBuster group (38 ± 27 versus 65 ± 53 h; p = 0.01). Chest wound chronic pain appeared slightly less frequent amongst PainBuster patients (1/7 patients or 14%) than amongst propensity matched control patients (5/11 patients or 45%, p = 0.23). Conclusions: A non-significantly greater proportion of patients receiving the PainBuster local anaesthetic intervention were discharged from ICU in less than 48 h. There was a shorter the time to ICU discharge and proportion of patients with chronic pain in patients treated with local anaesthetic compared to the matched control groups was non-significantly lower. A large, randomised controlled trial is underway to determine the impact of this technique on these important outcomes more reliably. doi:10.1016/j.hlc.2010.06.563
of Cardiothoracic Surgery, Princess Alexandra Hospital, Australia 2 Department of Medicine, University of Queensland, Australia Background: Several studies have shown disparate findings regarding body mass index (BMI) and outcomes after CABG. We sought whether BMI and other clinical variables predicted morbidity and mortality after primary CABG. Methods: Data on 4425 pts (3510 [79%] men; age 64 ± 9.8) were prospectively collected from 1998 to 2009. Patients were divided into underweight [UW, BMI < 20, 69 (1.6%)], normal weight [NW, BMI 20–29, 2878 (65%)], obese [OB, BMI 30–39, 1412 (32%)] and morbidly obese [MO, BMI ≥ 40, 66 (1.4%)]. Mean BMI was 28 ± 4.5. Multiple logistic regression was used for correlates of 30-day outcome of the entire group. Cox regression was used for predictors of late outcome in UW and MO. Results: There were 45 (1%) 30-day mortality and 234 (5%) 30-day morbidity. Mean follow-up was 44 ± 34 months. 10/134 (7.5%) late deaths in UW and MO. UW were significantly older (67 ± 10) and MO were significantly younger (59 ± 9) than the others (p < 0.0001). Independent correlates of 30-day morbidity were smoking (HR = 0.45; p −0.005), logistic Euroscore (HR = 0.03; p = 0.002), blood (HR = 1.61; p < 0.0001) and blood products (HR = 1.01; p < 0.0001). Correlates of 30-day mortality were logistic Euroscore (HR = 0.11; p < 0.0001) and blood (HR = 1.20; p < 0.0001). The only independent predictor of late death in UW and MO was pre-op arrhythmias (HR 1.84; p = 0.003). BMI was not a predictor of 30-day morbidity (p = 0.06), early death (p = 0.34) or late death (p = 0.18). 1 year, 3 years and 7 years survival were not significantly different [p = 0.14] between UW (97%, 92%, 91%) and MO (98%, 98%, 95%). Conclusion: BMI did not affect short or long-term outcomes after primary CABG. doi:10.1016/j.hlc.2010.06.564 553 Beyond Serum Creatinine: Creatinine Clearance is a Better Predictor of Postoperative Renal Dysfunction, and Outcomes Following Cardiopulmonary Bypass S. Galvin 1,∗ , A. El-Gamel 1,2,∗ 1 Waikato 2 King’s
Hospital, Hamilton, New Zealand College Hospital, London, England, United Kingdom
Introduction: Renal failure after cardiac surgery is a well known risk factor for perioperative morbidity and mortality. Although serum creatinine (sCr) is an accepted marker for renal dysfunction, a number of patients with normal
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268