Key result
Intraoperative blood transfusion was independently associated with a significantly increased risk of adverse postoperative cardiac events (OR 2.3) in patients undergoing non-cardiac surgery.
Why the study?
Do intraoperative events predict adverse perioperative cardiac outcomes in patients undergoing non-cardiac surgery?
Systematic Review
Do intraoperative events predict adverse perioperative cardiac outcomes in patients undergoing non-cardiac surgery?
Intraoperative events, particularly blood transfusion, vascular surgery, and emergent surgery, significantly increase the risk for postoperative cardiac complications in non-cardiac surgery.
Answers are grounded in this paper and cite their sources.
May support restrictive transfusion strategies in non-cardiac surgery; extends meta-analytic evidence on intraoperative cardiac risk factors.
BACKGROUND: Patients undergo cardiac preoperative evaluation to identify those at risk of adverse perioperative cardiac events. The Revised Cardiac Risk index is commonly used for this task, although it is unable to accurately risk stratify in all patients. This may be partly a result of intraoperative events which significantly modify preoperative risk. METHODS: We conducted a systematic review to identify independent intraoperative predictors of adverse cardiac events in patients undergoing non-cardiac surgery. Four databases (Ovid Healthstar 1966 to Jan 2012, Ovid Medline 1946 to 6 March 2012, EMBASE 1974 to March 05 2012 and The Cochrane Library to March 06 2012) were searched. RESULTS: Fourteen eligible studies were identified. The need for intraoperative blood transfusion (odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.3), vascular surgery (OR, 2.3; 95% CI, 1.2-3.4) and emergent/urgent surgery (OR, 2.3; 95% CI, 1.1-3.5) were the only independent intraoperative risk predictors identified in more than study. Other independent intraoperative factors identified included a >20 mmHg fall in mean arterial blood pressure for > 60 min (OR, 3.0; 95% CI, 1.8-4.9), >30% increase in baseline systolic pressure (OR, 8.0; 95% CI, 1.3-50), tachycardia in the recovery room (>30 beats per min (bpm) from baseline for >5 min) (OR, 7; 95% CI, 1.9-26), new onset atrial fibrillation (OR, 6.6; 95% CI, 2.5-20), hypothermia (OR, 2.2; 95% CI, 1.1-5) and remote ischemic preconditioning (OR, 0.22; 95% CI, 0.07-0.67). Other markers of surgical complexity were not independently associated with postoperative adverse cardiac outcomes. None of these studies controlled for blood transfusion. CONCLUSIONS: Intraoperative events significantly increase the risk for postoperative cardiac complications, although only intraoperative blood transfusion has strong evidence supporting this finding. It is possible that modification of these intraoperative risk factors by anesthetists and surgeons may reduce postoperative cardiac events and improve outcome. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study will add important information to understanding intraoperative risk factors for adverse cardiac events.
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Biccard et al. (2013) conducted a systematic review in Non-cardiac surgery. Intraoperative blood transfusion vs. No intraoperative blood transfusion was evaluated on Adverse postoperative cardiac events (OR 2.3, 95% CI 1.4-3.3). Intraoperative blood transfusion was independently associated with a significantly increased risk of adverse postoperative cardiac events (OR 2.3) in patients undergoing non-cardiac surgery.
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