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World Journal of Surgery

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01-08-2016 | Original Scientific Report

Major Cardiac Events After Non-cardiac Surgery

Authors: Gabriela Sousa, Ana Lopes, Pedro Reis, Vasco Carvalho, Alice Santos, Fernando José Abelha

Published in: World Journal of Surgery | Issue 8/2016

Abstract

Introduction

Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery.

Methods

The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE.

Results

A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO₂) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81–140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12–5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49–3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66–5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01–1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00–1.01).

Conclusions

FiO₂, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144CrossRefPubMed

Naughton C, Feneck RO (2007) The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. Int J Clin Pract 61(5):768–776CrossRefPubMed

Mangano DT (2004) Perioperative medicine: NHLBI working group deliberations and recommendations. J Cardiothorac Vasc Anesth 18(1):1–6CrossRefPubMed

Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499CrossRefPubMed

Mangano DT, Browner WS, Hollenberg M et al (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 323(26):1781–1788CrossRefPubMed

Maia PC, Abelha FJ (2008) Predictors of major postoperative cardiac complications in a surgical ICU. Rev Port Cardiol 27(3):321–328PubMed

Lawrence VA, Hilsenbeck SG, Mulrow CD et al (1995) Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 10(12):671–678CrossRefPubMed

Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049CrossRefPubMed

Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335(23):1713–1720CrossRefPubMed

10.

Wolfe Barry JA, Barth JH, Howell SJ (2008) Cardiac troponins: their use and relevance in anaesthesia and critical care medicine. Contin Educ Anaesth Crit Care Pain 8(2):62–66CrossRef

11.

Mangano DT, Hollenberg M, Fegert G et al (1991) Perioperative myocardial ischemia in patients undergoing noncardiac surgery—I: incidence and severity during the 4 day perioperative period. The Study of Perioperative Ischemia (SPI) Research Group. J Am Coll Cardiol 17(4):843–850CrossRefPubMed

12.

Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRefPubMed

13.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270(24):2957–2963CrossRefPubMed

14.

Alpert JS, Thygesen K, Antman E et al (2000) Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36(3):959–969CrossRefPubMed

15.

Priebe HJ (2004) Triggers of perioperative myocardial ischaemia and infarction. Br J Anaesth 93(1):9–20CrossRefPubMed

16.

Devereaux PJ, Xavier D, Pogue J et al (2011) Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 154(8):523–528CrossRefPubMed

17.

Gualandro DM, Campos CA, Calderaro D et al (2012) Coronary plaque rupture in patients with myocardial infarction after noncardiac surgery: frequent and dangerous. Atherosclerosis 222(1):191–195CrossRefPubMed

18.

Badner NH, Knill RL, Brown JE et al (1998) Myocardial infarction after noncardiac surgery. Anesthesiology 88(3):572–578CrossRefPubMed

19.

Biccard BM (2014) Detection and management of perioperative myocardial ischemia. Curr Opin Anaesthesiol 27(3):336–343CrossRefPubMed

20.

Roongsritong C, Warraich I, Bradley C (2004) Common causes of troponin elevations in the absence of acute myocardial infarction: incidence and clinical significance. Chest 125(5):1877–1884CrossRefPubMed

21.

Ford MK, Beattie WS, Wijeysundera DN (2010) Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 152(1):26–35CrossRefPubMed

22.

Davis C, Tait G, Carroll J et al (2013) The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9519 consecutive elective surgical patients. Can J Anaesth 60(9):855–863CrossRefPubMed

23.

Abdelmalak BB, Cata JP, Bonilla A et al (2013) Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: an observational study. Br J Anaesth 110(2):241–249CrossRefPubMed

24.

Moreno R, Morais P (1997) Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive Care Med 23(2):177–186CrossRefPubMed

25.

Abelha FJ, Botelho M, Fernandes V et al (2010) Quality of life and mortality assessment in patients with major cardiac events in the postoperative period. Rev Bras Anestesiol 60(3):268–284PubMed

26.

Fleischmann KE, Goldman L, Young B et al (2003) Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med 115(7):515–520CrossRefPubMed

27.

Musallam KM, Tamim HM, Richards T et al (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378(9800):1396–1407CrossRefPubMed

28.

Wu WC, Schifftner TL, Henderson WG et al (2007) Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 297(22):2481–2488CrossRefPubMed

29.

Reilly DF, McNeely MJ, Doerner D et al (1999) Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 159(18):2185–2192CrossRefPubMed

30.

Wiklund RA, Stein HD, Rosenbaum SH (2001) Activities of daily living and cardiovascular complications following elective, noncardiac surgery. Yale J Biol Med 74(2):75–87PubMedPubMedCentral

Title: Major Cardiac Events After Non-cardiac Surgery
Authors: Gabriela Sousa
Ana Lopes
Pedro Reis
Vasco Carvalho
Alice Santos
Fernando José Abelha
Publication date: 01-08-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3476-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Major Cardiac Events After Non-cardiac Surgery

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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