Preoperative and intraoperative risk factors, including mean arterial pressure < 50 mmHg, significantly predicted 30-day cardiac adverse events, which occurred in 1.1% of patients.
Observational (n=7,740)
No
What are the preoperative and intraoperative predictors of cardiac adverse events after noncardiac surgery?
The inclusion of intraoperative elements, such as operative duration and blood transfusions, alongside preoperative factors improves the prediction of perioperative cardiac adverse events after noncardiac surgery.
BACKGROUND: The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. METHODS: The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. RESULTS: Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure 100 (22% vs. 34%, P = 0.05). CONCLUSIONS: In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.
Kheterpal et al. (Wed,) conducted a observational in noncardiac surgery (n=7,740). Preoperative and intraoperative risk factors was evaluated on cardiac adverse events (CAEs) within the first 30 postoperative days. Preoperative and intraoperative risk factors, including mean arterial pressure < 50 mmHg, significantly predicted 30-day cardiac adverse events, which occurred in 1.1% of patients.
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