Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes After Cardiac Surgery: A Nationwide Cohort Study.

Abstract

Evidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce. Does perioperative PAC use decrease 1-year all-cause mortality in patients undergoing cardiac surgery? This nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume. A total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted OR, 0.81; 95% CI, 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction < .001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality after isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared with the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (< 100 cases/y; OR, 0.70; 95% CI, 0.65-0.76). Perioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was driven predominantly by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.