Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study

Figures

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  Fig. 1.. Study flowchart of patients with or without perioperative adverse cardiac events (PACE). We extracted the records of 277,276 adult patients over 18 years of age who underwent surgery for the first time at the hospital and had medical records for more than 180 days before surgery from deidentified data of 8,615,571 patients in South Korea’s standardized eletronic medical records (EMR) databases. After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. AUMC: Ajou University Medical Center, KHMC: Kyung Hee University Hospital, KHNMC: Gandong Kyung Hee University Hospital, KDH: Kangdong Sacred Heart Hospital, PNUH: Pusan National University Hospital, GNUH: Gyeongsang National University Hospital, WKUH: Wonkwang University Hospital.

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  Fig. 2.. Covariate balance plot before and after propensity score matching (PSM) across seven hospitals. After PSM, we plotted the absolute standard deviation (ASD) of the covariates to validate the adequacy of matching. After PSM, most of the ASD of the covariates is smaller than 0.1 that shows that matching is balanced and adequate. AUMC: Ajou University Medical Center, GNUH: Gyeongsang National University Hospital, KDH: Kangdong Sacred Heart Hospital, WKUH: Wonkwang University Hospital, KHMC: Kyung Hee University Hospital, KHNMC: Gandong Kyung Hee University Hospital, PNUH: Pusan National University Hospital.

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  Fig. 3.. (A) The forest plot represents the meta-analysis results for the risk of one-year mortality in patients with perioperative adverse cardiac events (PACE) across seven hospitals. The hazard ratio (HR) and 95% CIs are indicated by the diamond shape for the combined effect estimate and the squares for each individual study. The size of the square represents the weight of each study. The horizontal line represents the CI, and the diamond shape represents the overall pooled effect estimate. The four numbers within each column represent the number of patients with PACE with outcome (death), without outcome, and patients without PACE with outcome, without outcome, respectively. (B) The forest plot represents the meta-analysis results for the risk of three-year mortality in patients with PACE across seven hospitals. The HRs and 95% CIs are presented in the same way as in (A). AUMC: Ajou University Medical Center, GNUH: Gyeongsang National University Hospital, KDH: Kangdong Sacred Heart Hospital, KHMC: Kyung Hee University Hospital, KHNMC: Gandong Kyung Hee University Hospital, PNUH: Pusan National University Hospital, WKUH: Wonkwang University Hospital.

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  Fig. 4.. The figure shows one-year mortality survival plot across seven hospitals. Each Kaplan-Meier plot shows cumulative incidence of the perioperative adverse cardiac events (PACE) that is defined as a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke. The P value was calculated by the log-rank test. The insets show the same data on enlarged y axes. ‘PACE O’ denotes patients with PACE, ‘PACE X’ denotes patients without PACE. AUMC: Ajou University Medical Center, GNUH: Gyeongsang National University Hospital, KDH: Kangdong Sacred Heart Hospital, KHMC: Kyung Hee University Hospital, KHNMC: Gandong Kyung Hee University Hospital, PNUH: Pusan National University Hospital, WKUH: Wonkwang University Hospital.

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  Fig. 5.. Risk of one-year mortality in patients with perioperative adverse cardiac events (PACE) stratified by the European Society of Cardiology / European Society of Anaesthesiology surgery risk classification. AUMC: Ajou University Medical Center, GNUH: Gyeongsang National University Hospital, KDH: Kangdong Sacred Heart Hospital, KHMC: Kyung Hee University Hospital, KHNMC: Gandong Kyung Hee University Hospital, PNUH: Pusan National University Hospital, WKUH: Wonkwang University Hospital.