R.B. Madera1, I. Pesselev1, K. Murgas1, D. Albano1, A. Plank1, A. Dhamija1 1Stony Brook University Medical Center, Stony Brook, NY, USA
Introduction:
Currently, a gap exists in the literature regarding the postoperative complications faced by patients with polycythemia vera after undergoing cardiac valve replacement procedures. In this study, we characterize these risks to aid clinicians in decision-making for this specific patient cohort.
Methods:
The data used in this retrospective cohort study was collected from the TriNetX Global Collaborative Network (with NLP), which provided access to the electronic medical records of approximately 150 million patients from 125 healthcare organizations. Using ICD-10-PCS and SNOMED codes we screened for patients in the network who underwent a cardiac valve replacement surgery and segregated them based on those with and without a polycythemia vera diagnosis (ICD-10-CM-D45) in their medical records. Using TriNetX analytics, the patients from each cohort were matched based on age, sex, and race. Subsequently, we compared each cohort's risk of experiencing selected outcomes within a 30-day postoperative period. The data utilized in this study is a secondary analysis of existing deidentified data and therefore is exempt from our hospital institutional review board.
Results:
Within TriNetX, we identified 236,094 patients who underwent lobectomy procedures, 366 (0.272%) of which had a polycythemia vera diagnosis. After propensity score matching, we assigned 614 patients to each cohort (polycythemia vera and control), operated on in the US from 2002 through 2024. Examining the post-operative outcomes within 30 days after lobectomy procedures for each cohort, we identified statistically significant complications for which the polycythemia vera group was at a greater risk including: pneumonia (RR: 2.12, 95% CI: 1.335-3.366, p: 0.0011), pneumothorax (RR: 1.75, 95% CI: 1.073-2.853, p: 0.0227), acute MI (RR: 1.95, 95% CI: 1.151-3.304, p: 0.0112), cardiac arrhythmias (RR: 1.446, 95% CI: 1.099-1.903, p: 0.0079), cerebral infarction (RR: 3.286, 95% CI: 1.826-5.914, p: <0.0001), sepsis (RR: 2.1, 95% CI: 0.997-4.422, p: 0.0454), acute kidney failure (RR: 1.452, 95% CI: 1.072-1.966, p: 0.0153), atrial fibrillation (RR: 1.252, 95% CI: 1.02-1.536, p: 0.0307), atelectasis (RR: 1.369, 95% CI: 1.058-1.772, p: 0.0164). Additional outcomes that did not have a significant association with either cohort include: infection following a procedure, acute respiratory failure, hemothorax, pulmonary embolism, pleural effusion, pericardial effusion, complications of cardiac and vascular prosthetic devices, cardiac tamponade, and death.
Conclusion:
Our study reveals that patients with polycythemia vera who undergo cardiac valve replacement procedures face a heightened risk of serious post-operative complications. These findings indicate the need for enhanced perioperative care for this patient group to reduce these risks. Future research should focus on understanding the pathological mechanisms behind these complications and developing strategies for their prevention.