EFFECT OF HYPOPHOSPHATEMIA ON POST OPERATIVE OUTCOMES IN CARDIAC SURGERY

Abstract

Objective: To establish association of phosphorus levels with surgical outcomeof patients in our setup.

Methodology: This was an case control study conducted at Department ofCardiac Surgery, Civil Hospital Karachi from May 2015 to August 2015 .Phosphorus levels were measured at three points of hospital stay; a)preoperatively b) immediately post operatively and c) at first post operative day.Patients were divided in two groups according to immediate post operativephosphate levels; those with hypophosphatemia (<2.7 mg/dl) and a controlgroup with normal phosphate levels (2.7-4.5 mg/dl). Pre and post operativemanagement including duration of Heart Lung Machine, cross clamp, duration ofventilation, ICU Stay, cardio active support needed and amount of blood loss,use of IABP and mortality were recorded.

Result: A total of 55 patients were included in the study .Hypophosphatemiawas found in 27.3% patients immediately after surgery and 38.2% patients at firstpost operative day. No significant difference was found in intra operativemanagement of patient. However, post operative course of both groups differedsignificantly 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 significantlymore blood loss (998.7±1217.8 versus 526.8±322.0, p=0.001) and receivedmore blood transfusions post operatively (1.80±2.09 versus 0.8±0.9,p=0.009). No significant difference of post operative mortality was found in bothgroups (15.3% versus 3.2%, p=0.07).

Conclusion: Hypophosphatemia is documented in one third of postoperativecardiac surgery patients and is associated with prolonged ventilation, duration ofICU stay and inotropic support with more blood loss.