Is Hypothyroidism Overlooked in Cardiac Surgery Patients?

Objectives: To analyze adequacy of preoperative thyroid screening of cardiac surgery patients (pts) with hypothyroidism (HT) and compare with pts without HT by demographic data, EuroSCORE (ES) scores, early and late outcomes. Patients: From 1000 cardiac surgery pts from Jan 1999 through May 2000 pts with HT were identified (Group 1, n = 80). 920 pts (Group 2) had no HT. Results: Group 1 pts were older (p < 0.0001), had more females (p < 0.0001), more pts with CHF p < 0.0001, more pts in NYHA class III-IV (p = 0.01) and higher ES risk scores by both algorithms (p = 0.003 and p < 0.0001 consecutively) than Group 2 pts. ES variables demonstrated higher number of pts > 60 years (p = 0.004), more females (p < 0.0001) and higher number of other than CABG surgery pts (p = 0.01) in Group 1. 47 (58.8%) had adequate laboratory tests. 15 (18.8%) had no tests and 18 (22.5%) inadequate tests. 10 (12.5%) pts had no replacement therapy. There was no operative mortality in Group 1 and 14 (1.5%) in Group 2 (p = 0.70). Hospital mortality was higher in Group 1 (6/7.5% vs. 37/4.5%), p = 0.03. Stay in postoperative intensive care unit and hospital were similar (p = 0.66 and 0.53). More pts in Group 1 needed prolonged ICU and LOS (p < 0.0001 for both). Occurrence of postoperative AF was higher in Group 1, p < 0.02. Seventeen pts (23.0%) were not discharged home in Group 1 and 87 (10.2%) in Group 2, (p = 0.002). Follow-up mortality was higher in Group 1 (45/58.1% vs. 378/43.5%, p = 0.02). Conclusions: HT is overlooked in cardiac surgery patients. Long-term mortality is higher in pts with HT. Resource utilization is higher in pts with HT.