Maheen Naeem1, Adnan Ali1, Faiza Anees1, Mudassir Iqbal1
1Dow University of Health Sciences, Karachi, Pakistan
Objective: To establish an association of phosphorus levels with the surgical outcome of patients in our setup.
This was a case-control study conducted at the Department of Cardiac Surgery, Civil Hospital Karachi from May 2015 to August 2015. Phosphorus levels were measured at three points of hospital stay; a)preoperatively b) immediately postoperatively and c) at first postoperative day. Patients were divided into two groups according to immediate post-operative phosphate levels; those with hypophosphatemia (<2.7 mg/dl) and a control group with normal phosphate levels (2.7-4.5 mg/dl). Pre and post-operative management including duration of Heart Lung Machine, cross-clamp, duration of ventilation, ICU Stay, cardioactive support needed and amount of blood loss,use of IABP and mortality were recorded.
A total of 55 patients were included in the study. Hypophosphatemia was found in 27.3% of patients immediately after surgery and 38.2% of patients on the first postoperative day. No significant difference was found in the intraoperative management of the patient. However, the postoperative course of both groups differed significantly in two groups in terms of duration of ventilation (11.9±11.6 versus6.1±5.5 hours, p=0.002), duration of ICU stay (3.5±1.5 versus 2.4±0.7 days,p=0.01) and duration of inotropic support needed (45.5±31.2 versus 25.0±12.4 hours, p=0.001). Patients with hypophosphatemia had significantly more blood loss (998.7±1217.8 versus 526.8±322.0, p=0.001) and received more blood transfusions postoperatively (1.80±2.09 versus 0.8±0.9,p=0.009). No significant difference in postoperative mortality was found in both groups (15.3% versus 3.2%, p=0.07).
Hypophosphatemia is documented in one-third of postoperative cardiac surgery patients and is associated with prolonged ventilation, duration of ICU stay and inotropic support with more blood loss.