What question did this study set out to answer?

To identify preoperative clinical, risk-index, and radionuclide predictors of perioperative cardiac complications in elderly patients undergoing noncardiac surgery.

December 1, 1985Annals of Internal Medicine

Cardiac Prognosis in Noncardiac Geriatric Surgery

Q: What does this research mean for the field?

The inability to perform two minutes of supine bicycle exercise to raise heart rate above 99 beats per minute is an independent predictor of perioperative cardiac complications in geriatric patients undergoing noncardiac surgery, providing predictive value superior to standard clinical and radionuclide data. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Why the study?

Does the inability to perform 2 minutes of supine bicycle exercise predict perioperative cardiac complications in geriatric patients undergoing noncardiac surgery?

Population

155 patients aged 65 years or older scheduled for elective abdominal or noncardiac thoracic surgery.

Comparison

Preoperative assessment of inability to do 2… vs Standard clinical assessment and rest/exercise…

Design

Cohort

Follow-up

perioperative

Authors

MGMyron C. GersonUniversity of Cincinnati JHJames M. HurstBeth Israel Deaconess Medical Center VHVicki HertzbergGeorgia Institute of Technology

Discussion

Member takes

Implication

May support simple exercise testing for perioperative risk stratification in geriatric noncardiac surgery patients; leaves open need for prospective validation.

Key Points

To identify preoperative clinical, risk-index, and radionuclide predictors of perioperative cardiac complications in elderly patients undergoing noncardiac surgery.
Evaluated 100 patients aged ≥65 years scheduled for elective abdominal or noncardiac thoracic surgery using standard clinical data, Dripps class, Goldman cardiac risk index, and rest/exercise radionuclide ventriculography.
Prospectively validated the identified risk predictors in an independent cohort of 55 additional geriatric surgical patients.
In the initial cohort (N=100), 13 patients experienced perioperative cardiac complications and 6 died, with inability to complete 2 minutes of supine bicycle exercise to reach >99 beats/min serving as the key predictor (sensitivity 85%, specificity 64%).
In the prospective cohort (N=55), inability to perform the exercise protocol was the only independent predictor of perioperative complications (p < 0.05), whereas rest and exercise radionuclide ventriculography added little prognostic value.

Structured PICO

Does the inability to perform 2 minutes of supine bicycle exercise predict perioperative cardiac complications in geriatric patients undergoing noncardiac surgery?

Population

155 patients (100 in initial study, 55 in prospective testing) aged 65 years or older scheduled for elective abdominal or noncardiac thoracic surgery.

Intervention

Preoperative assessment of inability to do 2 minutes of bicycle exercise in the supine position to raise the heart rate above 99 beats/min.

Comparator

Standard clinical assessment (history, physical examination, chest roentgenogram, electrocardiogram, laboratory data, ASA class, Goldman cardiac risk index) and rest/exercise radionuclide ventriculograms.

Outcome

Perioperative complications, including cardiac death, ventricular tachycardia or fibrillation, and heart failure or myocardial infarction.composite

The inability to perform 2 minutes of supine bicycle exercise is a strong independent predictor of perioperative cardiac complications in geriatric patients undergoing noncardiac surgery, outperforming standard clinical indices and radionuclide ventriculography.

Cite This Study

Gerson et al. (1985) studied this question.

synapsesocial.com/papers/6a1908c9a6ebdba58ad31940 https://doi.org/10.7326/0003-4819-103-6-832

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Implication

May support simple exercise testing for perioperative risk stratification in geriatric noncardiac surgery patients; leaves open need for prospective validation.

Cardiac Prognosis in Noncardiac Geriatric Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Cardiac Prognosis in Noncardiac Geriatric Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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