Maheen Naeem, Adnan Ali Khahro, Faiza Anees, Mudassir Iqbal Dar.
Effect of hypophosphatemia on post operative outcomes in cardiac surgery.
Pak Heart J Jan ;50(2):116-21.

Objective: To establish association of phosphorus levels with surgical outcome of patients in our setup. Methodology: This was an case control study conducted at 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 post operatively and c) at first post operative day.Patients were divided in 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, 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. Hypophosphatemia was found in 27.3% patients immediately after surgery and 38.2% patients at first post operative day. No significant difference was found in intra operative management of patient. However, post operative course of both groups differed significantly in two groups in terms of duration of ventilation (11.9+-11.6 versus 6.1+-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 post operatively (1.80+-2.09 versus 0.8+-0.9,p=0.009). No significant difference of post operative mortality was found in both groups (15.3% versus 3.2%, p=0.07). Conclusion: 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.

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