Postoperative care after cardiac surgery

Abstract

The basic evaluation is required for every patient who undergoes open heart surgery. In emergency situations, this information may not be available or obtainable if lifesaving emergency surgery is the only chance for survival. In other patients, the presence of comorbid conditions or the severity of heart disease requires additional information to assess both the potential benefits and risks of operation. The basic evaluation includes history, physical examination, blood testing, urinalysis, chest x-ray, electrocardiogram, and almost always cardiac catheterization. Each of these components of the basic evaluation should be performed with the planned surgical procedure in mind. For example, if coronary artery bypass grafting is planned, the history should indicate prior phlebitis or vein stripping; if a mitral prosthesis must be replaced, a previous deep postoperative sternotomy wound infection is relevant (Clark et al., 2004) The Society of Thoracic Surgeons has been collecting clinical cardiac surgery data since 1989. From this extensive database we have been able to identify many of the major perioperative complications, their association with patient characteristics, and attempts at modification by therapies. In a 2003 analysis of the data, the 30-day operative mortality was 3.05%, and the major complication rate was 13.04%. The major complications reported were renal failure, stroke, prolonged ventilation, reoperation, and sternal infection. Preoperative patient characteristics are important contributors to postoperative complications in all these areas. Postoperative complications may be due to preoperative patient illnesses, to unavoidable consequences of operative decisions, or to technical complications. By carefully recording these morbid events, we are able to provide a better-quality service for our patients(Egleston et al., 2005).