Intraoperative central venous oxygen saturation and patient outcome in patients undergoing major abdominal surgery
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KeywordsCentral Venous Catheter Postoperative Outcome Urinary Catheter Arterial Lactate Operative Severity
Low central venous saturation (ScvO2) in the post-operative period is associated with poor outcome. We examined whether intraoperative ScvO2 is a predictor of outcome based on the postoperative morbidity survey (POMS) and length of hospital stay. The POMS is a method for describing complications associated with major surgery . It comprises a nine-point survey and provides a generic measure of short-term postoperative outcome.
Prospective ScvO2 values were collected from patients undergoing major abdominal surgery. This was done by intermittent sampling of blood obtained from the distal lumen of a central venous catheter placed in the jugular vein. The POMS was used to assess outcome on postoperative days 1, 3, 5, 8, 15 and 21 if applicable. To accommodate local practice, however, we excluded urinary catheter, pain and mobility from the POMS as it was not a true reflection of organ dysfunction in our study population. We evaluated other individual postsurgical complications as outlined in the POMS to establish whether intraoperative median, minimum and ΔScvO2 (end of surgery value minus start of surgery value) are related to outcome.
Fifty-two patients (average age 67.8, SD 12.0) were included. The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity revealed a predicted morbidity of 54.2% and mortality of 3.3%. The commonest complications were gastrointestinal and infection (58.7% and 19.2%, respectively). We found no correlation between median, minimum and ΔScvO2 with postoperative complication and length of hospital stay. However, ΔScvO2 for patients who exhibited postoperative complication on day 3 was significantly different from the patients who did not (P = 0.035) but the actual difference was only 2%. Minimum ScvO2 correlated weakly with high arterial lactate measured at the end of the procedure (Spearman r = 0.32, P = 0.025).
Intraoperative central venous saturation in patients undergoing major abdominal surgery is not related to postoperative outcome or length of hospital stay.
This article is published under license to BioMed Central Ltd.