Determinantes de internação prolongada após cirurgia cardíaca: impacto da cardiopatia reumática

Abstract

Background: Despite the reduction in the incidence of rheumatic fever (RF) in developed countries with consequent reduction in the prevalence of chronic rheumatic heart disease, RF remains a major public health problem, especially in developing countries. RF affects mainly children and young adults. The most severe manifestation is carditis, which leads to chronic disability in early stages of the life, resulting in high social and economic cost. Objective: To verify the impact of rheumatic heart disease as a determinant of prolonged hospitalization after cardiac surgery at Hospital das Clínicas of the Federal University of Minas Gerais (HC/UFMG). Methods: This study included consecutively and prospectively all adult patients (18 years or more) who were admitted at the HC/UFMG for elective or urgent cardiac surgery from June 2010 to June 2011. Heart transplant patients or implantation of devices, including the pacemaker, were not included. The postoperative evolution of patients was followed by the researcher until hospital discharge or death. The outcome of interest was prolonged length of stay, defined as a length of stay greater than or equal to the 75th percentile for length of stay for each operation, including the day of discharge. Results: A total of 164 patients were included, and rheumatic valve disease was present in 32 patients (20%). The rheumatic patients were younger, used fewer medications and had less associated comorbidities than the non-rheumatic patients. The types of cardiac surgeries performed were coronary artery bypass graft surgery (CABG) (n=86), valve replacement (n=59), atrial septal defect correction (n=10), combined surgery (CABG with valve replacement) (n=7), and mitral valve repair (n=2). All rheumatic patients had undergone to valve replacement and 63% of them had had cardiac surgery. Forty-one patients were computed as prolonged length of hospital stay; 11 (34%) patients with rheumatic and 30 (23%) non-rheumatic fever. In the multivariate analysis, RD remained an important predictor of prolonged hospitalization, independent of infective endocarditis, surgery duration, mechanical ventilation time, and postoperative pneumonia. Conclusion: Rheumatic fever is still prevalent among patients undergoing cardiac surgery, and was determining factor of prolonged hospital stay and increased postoperative morbidity.