Cardiac Surgery in Patients with Parkinson's Disease: A Retrospective Analysis of a High-Risk Cohort
06 March 2017
24 April 2017
11 June 2017 (eFirst)
Background Little is known about the perioperative course of patients with Parkinson's disease (PD) undergoing cardiac surgery. The objective of this study was to identify the influence of PD on the perioperative course and to improve treatment.
Methods Perioperative data were analyzed retrospectively from 130 patients undergoing cardiac surgery between September 2001 and April 2013 who had PD and were compared using 1:1 matched-pair analysis with 130 controls not affected by PD.
Results The 30-day all-cause mortality (4.6 vs. 9.2%; p = 0.21; odds ratio [OR] = 0.45; 95% confidence interval [CI]: 0.16, 1.31) and the overall all-cause mortality (27.7 vs. 28.5%; hazard ratio [HR] = 0.96 [0.56, 1.66]; p = 1.00) were not significantly different between PD patients and the control group. Emergency surgery (p = 0.04; OR = 3.20; 95% CI: 1.06, 9.66) and postoperative pneumonia (p < 0.001; OR = 11.3; 95% CI: 3.06, 41.6) were associated with 30-day mortality. Independent predictors of all-cause mortality were age at surgery (p = 0.01; OR = 3.58; 95% CI: 1.38, 9.30), NYHA (New York Heart Association) classification stage IV (p = 0.02; OR = 17.3; 95% CI: 1.52, 198), and postoperative pneumonia (p = 0.05; OR = 46.4; 95% CI: 0.97, 2219). We did not observe an association of PD with short- or long-term all-cause mortality after adjustment for associated covariates.
Conclusions We found that PD is not a significant risk factor for perioperative morbidity and mortality in our cohort. Our study showed that patients with PD had outcomes that were similar to those of non-PD patients.
KeywordsParkinson's disease - perioperative risk - perioperative complications - high-risk patients - cardiac surgery
Presented at the 28th EACTS Annual Meeting 2014 in Milan, Italy.
* Both authors contributed equally to the manuscript.
- 1 Parkinson J. An Essay on the Shaking Palsy. London: Whittingham and Rowland; 1817
- 2 Lang AE, Lozano AM. Parkinson's disease. First of two parts. N Engl J Med 1998; 339 (15) 1044-1053
- 3 von Campenhausen S, Bornschein B, Wick R. , et al. Prevalence and incidence of Parkinson's disease in Europe. Eur Neuropsychopharmacol 2005; 15 (04) 473-490
- 4 Wüllner U, Standop J, Kaut O, Coenen V, Kalenka A, Wappler F. Parkinson's disease. Perioperative management and anesthesia [in German]. Anaesthesist 2012; 61 (02) 97-105
- 5 Sekhon JS. Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw 42. (07). Doi: 10.18637/jss.v042.i07
- 6 Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 2008; 27 (12) 2037-2049
- 7 Newman MF, Kirchner JL, Phillips-Bute B. , et al; Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344 (06) 395-402
- 8 Burton DA, Nicholson G, Hall GM. Anaesthesia in elderly patients with neurodegenerative disorders: special considerations. Drugs Aging 2004; 21 (04) 229-242
- 9 Golden WE, Lavender RC, Metzer WS. Acute postoperative confusion and hallucinations in Parkinson disease. Ann Intern Med 1989; 111 (03) 218-222
- 10 Zheng KS, Dorfman BJ, Christos PJ. , et al. Clinical characteristics of exacerbations in Parkinson disease. Neurologist 2012; 18 (03) 120-124
- 11 Katus L, Shtilbans A. Perioperative management of patients with Parkinson's disease. Am J Med 2014; 127 (04) 275-280
- 12 Huang Y-P, Chen L-S, Yen M-F. , et al. Parkinson's disease is related to an increased risk of ischemic stroke-a population-based propensity score-matched follow-up study. PLoS One 2013; 8 (09) e68314
- 13 Pawliszak W, Kowalewski M, Raffa GM. , et al. Cerebrovascular events after no-touch off-pump coronary artery bypass grafting, conventional side-clamp off-pump coronary artery bypass, and proximal anastomotic devices: a meta-analysis. J Am Heart Assoc 2016; 5 (02) e002802
- 14 Pepper PV, Goldstein MK. Postoperative complications in Parkinson's disease. J Am Geriatr Soc 1999; 47 (08) 967-972
- 15 Mueller MC, Jüptner U, Wuellner U. , et al. Parkinson's disease influences the perioperative risk profile in surgery. Langenbecks Arch Surg 2009; 394 (03) 511-515
- 16 Mu L, Sobotka S, Chen J. , et al; Arizona Parkinson's Disease Consortium. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 2012; 71 (06) 520-530
- 17 Easdown LJ, Tessler MJ, Minuk J. Upper airway involvement in Parkinson's disease resulting in postoperative respiratory failure. Can J Anaesth 1995; 42 (04) 344-347
- 18 Bösel J, Schiller P, Hook Y. , et al. Stroke-related Early Tracheostomy versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT): a randomized pilot trial. Stroke 2013; 44 (01) 21-28
- 19 Marmot M. Smoking and Parkinson's disease. In: Wald N, Baron J. , eds. Smoking and Hormone Related Disorders. Oxford: Oxford University Press; 1990
- 20 Baron JA. Cigarette smoking and Parkinson's disease. Neurology 1986; 36 (11) 1490-1496
- 21 Sun Y, Chang YH, Chen HF, Su YH, Su HF, Li CY. Risk of Parkinson disease onset in patients with diabetes: a 9-year population-based cohort study with age and sex stratifications. Diabetes Care 2012; 35 (05) 1047-1049
- 22 Cereda E, Barichella M, Pedrolli C. , et al. Diabetes and risk of Parkinson's disease. Mov Disord 2013; 28 (02) 257-261
- 23 Qiu C, Hu G, Kivipelto M. , et al. Association of blood pressure and hypertension with the risk of Parkinson disease: the National FINRISK Study. Hypertension 2011; 57 (06) 1094-1100
- 24 Ben-Shlomo Y, Marmot MG. Survival and cause of death in a cohort of patients with parkinsonism: possible clues to aetiology?. J Neurol Neurosurg Psychiatry 1995; 58 (03) 293-299
- 25 Beyer MK, Herlofson K, Årsland D, Larsen JP. Causes of death in a community-based study of Parkinson's disease. Acta Neurol Scand 2001; 103 (01) 7-11
- 26 Pennington S, Snell K, Lee M, Walker R. The cause of death in idiopathic Parkinson's disease. Parkinsonism Relat Disord 2010; 16 (07) 434-437
- 27 Liang H-W, Huang Y-P, Pan S-L. Parkinson disease and risk of acute myocardial infarction: a population-based, propensity score-matched, longitudinal follow-up study. Am Heart J 2015; 169 (04) 508-514
- 28 Okun MS. Deep-brain stimulation for Parkinson's disease. N Engl J Med 2012; 367 (16) 1529-1538
- 29 Damiano AM, Snyder C, Strausser B, Willian MK. A review of health-related quality-of-life concepts and measures for Parkinson's disease. Qual Life Res 1999; 8 (03) 235-243
- 30 Dorsey ER, Constantinescu R, Thompson JP. , et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007; 68 (05) 384-386