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Does Right Heart Catheterization Prevent Perioperative Complications?

Does Right Heart Catheterization Prevent Perioperative Complications? To the Editor: In their observational study, Dr Polanczyk and colleagues1 found an increased incidence of congestive heart failure (CHF) in patients receiving perioperative right heart catheterization (RHC) for noncardiac surgery. They state that "diagnosis of perioperative CHF was obtained from progress notes recorded by clinicians involved in the patients' care." They do not indicate, however, whether the diagnosis of CHF was made in light of data obtained from RHC. It is possible that an elevated pulmonary capillary wedge pressure (PCWP) would have resulted in a diagnosis of CHF and thus resulted in medical therapy, which would then have been classified as a complication. If a certain level of postoperative PCWP was diagnostic of CHF, monitored patients who received RHC would be more likely to have this so-called complication. It is common knowledge that the clinical examination is less sensitive than RHC at detecting an abnormally high PCWP. The pertinent question is not whether RHC is needed in all patients, but whether interventions in response to information obtained from the catheter altered the outcomes in these observational studies. Absence of proof is not proof of absence. References 1. Polanczyk CARohde LEGoldman L et al. Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA. 2001;286:309-314.Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Does Right Heart Catheterization Prevent Perioperative Complications?

JAMA , Volume 286 (23) – Dec 19, 2001

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Publisher
American Medical Association
Copyright
Copyright © 2001 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.286.23.2940
Publisher site
See Article on Publisher Site

Abstract

To the Editor: In their observational study, Dr Polanczyk and colleagues1 found an increased incidence of congestive heart failure (CHF) in patients receiving perioperative right heart catheterization (RHC) for noncardiac surgery. They state that "diagnosis of perioperative CHF was obtained from progress notes recorded by clinicians involved in the patients' care." They do not indicate, however, whether the diagnosis of CHF was made in light of data obtained from RHC. It is possible that an elevated pulmonary capillary wedge pressure (PCWP) would have resulted in a diagnosis of CHF and thus resulted in medical therapy, which would then have been classified as a complication. If a certain level of postoperative PCWP was diagnostic of CHF, monitored patients who received RHC would be more likely to have this so-called complication. It is common knowledge that the clinical examination is less sensitive than RHC at detecting an abnormally high PCWP. The pertinent question is not whether RHC is needed in all patients, but whether interventions in response to information obtained from the catheter altered the outcomes in these observational studies. Absence of proof is not proof of absence. References 1. Polanczyk CARohde LEGoldman L et al. Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA. 2001;286:309-314.Google Scholar

Journal

JAMAAmerican Medical Association

Published: Dec 19, 2001

References