Affiliation:
1. Department of Surgery University of North Carolina at Chapel Hill 4001 Burnett Womack Building, CB 7050 27599 Chapel Hill NC USA
2. School of Medicine University of North Carolina at Chapel Hill 1001 Bondurant Hall, CB 9535 27599 Chapel Hill NC USA
3. Baylor College of Medicine 1 Moursund St 77030 Houston TX USA
4. Department of Surgery University of Minnesota 11‐132 Phillips‐Wangensteen Bldg., 516 Delaware Street SE 55455 Minneapolis MN USA
5. Department of Surgery UNC School of Medicine 4008 Burnett Womack Building, CB 7228 Chapel Hill USA
Abstract
AbstractBackgroundArrhythmias are common in critically ill patients, though the impact of arrhythmias on surgical patients is not well delineated. We aimed to characterize mortality following arrhythmias in critically ill patients.MethodsWe performed a propensity‐matched retrospective analysis of intensive care unit (ICU) patients from 2007 to 2017 in the Cerner Acute Physiology and Chronic Health Evaluation database. We compared outcomes between patients with and without arrhythmias and those with and without surgical indications for ICU admission. We also modeled predictors of arrhythmias in surgical patients.Results467,951 patients were included; 97,958 (20.9%) were surgical patients. Arrhythmias occurred in 1.4% of the study cohorts. Predictors of arrhythmias in surgical patients included a history of cardiovascular disease (odds ratio [OR] 1.35, 95% confidence interval [CI95] 1.11–1.63), respiratory failure (OR 1.48, CI95 1.12–1.96), pneumonia (OR 3.17, CI95 1.98–5.10), higher bicarbonate level (OR 1.03, CI95 1.01–1.05), lower albumin level (OR 0.79, CI95 0.68–0.91), and vasopressor requirement (OR 27.2, CI95 22.0–33.7). After propensity matching, surgical patients with arrhythmias had a 42% mortality risk reduction compared to non‐surgical patients (risk ratio [RR] 0.58, CI 95 0.43–0.79). Predicted probabilities of mortality for surgical patients were lower at all ages.ConclusionsSurgical patients with arrhythmias are at lower risk of mortality than non‐surgical patients. In this propensity‐matched analysis, predictors of arrhythmias in critically ill surgical patients included a history of cardiovascular disease, respiratory complications, increased bicarbonate levels, decreased albumin levels, and vasopressor requirement. These findings highlight the differential effect of arrhythmias on different cohorts of critically ill populations.