Diaphragm Dysfunction After Cardiac Surgery
Tim Somers, Sandy Iskander, Ad F. T. M. Verhagen, Wilson W. L. Li
Abstract
INTRODUCTION: Diaphragm elevation is commonly seen after cardiac surgery, mostly due to phrenic nerve injury. However, only historical data is available on the incidence of diaphragm elevation and its consequences during recovery. OBJECTIVE: We aim to provide contemporary insights into the incidence of diaphragm dysfunction in patients undergoing cardiac surgery and its effect on postoperative outcomes. METHODS: Records of all patients undergoing cardiac surgery through sternotomy between 2015 and 2016 at the Radboud University MedicalCentre were retrospectively reviewed. Diaphragm position and elevation were evaluated on available chest radiography. Right-sided diaphragm elevation was defined as the right diaphragm being > 3.0 cm above the left diaphragm; left-sided diaphragm elevation was defined as < 0.5 cm below or above the level of the right diaphragm. RESULTS: A total of 1510 patients have undergone cardiac surgery through sternotomy during the study period, of which 1316 patients were included in the final analysis. Of these 1316 patients, 13% (n = 179) had pre-existing diaphragm elevation, 27% (n = 351) had a new diaphragm elevation postoperative-y, and 60% (n = 786) had no diaphragm elevation. No statistically significant differences were found between the groups in the occurrence of postoperative (pulmonary) complications or mortality. Of patients who developed new diaphragm elevation postoperatively, 65% recovered in the follow-up period. CONCLUSION: New postoperative diaphragm elevation occurs in 27% of patients undergoing cardiac surgery. However, new postoperative diaphragm elevation is not associated with a higher incidence of postoperative complications and spontaneous recovery is seen in most patients.