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January 17, 2012AnaesthesiaOpen Access

Surgery and cardiovascular outcomes: an untapped public health benefit that potentially saves lives

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Key result

Low- to intermediate-risk surgery was associated with a 5% relative risk reduction for myocardial infarction or acute coronary syndrome compared with no surgery in a socially matched cohort.

Why the study?

Does hospitalisation for surgery reduce intermediate-term myocardial infarction or acute coronary syndrome in patients undergoing low- to intermediate-risk non-cardiac surgery?

Population

Patients undergoing low- to intermediate-risk non-cardiac surgery

Comparison

Hospitalisation for surgery (peri-operative care) vs Patients who did not have surgery

Design

Editorial

Follow-up

intermediate to long term

Authors

BBBruce Biccard

Discussion

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Member takes

Overview

Association may support perioperative CV optimization; hypothesis-generating and requires randomized trials before practice change.

Structured PICO

Does hospitalisation for surgery reduce intermediate-term myocardial infarction or acute coronary syndrome in patients undergoing low- to intermediate-risk non-cardiac surgery?

P
Population
Patients undergoing low- to intermediate-risk non-cardiac surgery
E
Exposure
Hospitalisation for surgery (peri-operative care)
C
Comparator
Patients who did not have surgery
O
Outcome
Intermediate-term outcome of myocardial infarction or acute coronary syndromehard clinical

Main Result

Effect estimate: RRR 5%

The peri-operative period for non-cardiac surgery represents a critical public health opportunity for anaesthetists and surgeons to optimize cardiovascular medical therapy and improve long-term outcomes.

Limitations

  • Selection bias where patients assessed as unfit for surgery are part of the control group.
  • The study was not designed a priori to confirm that surgery improves cardiovascular outcomes (hypothesis generating).
  • Selection bias where patients assessed as unfit for surgery are part of the control group
  • Hypothesis generating only, not designed a priori to confirm surgery improves cardiovascular outcome

Cite This Study

Bruce Biccard (2012) conducted an editorial in non-cardiac surgery. Low- to intermediate-risk surgery vs. No surgery was evaluated on Myocardial infarction or acute coronary syndrome (RRR 5%). Low- to intermediate-risk surgery was associated with a 5% relative risk reduction for myocardial infarction or acute coronary syndrome compared with no surgery in a socially matched cohort.

synapsesocial.com/papers/6a8adf13df3a83baf8ca98bdhttps://doi.org/10.1111/j.1365-2044.2011.07027.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery2009 · 741 citations
  2. 2Regional and Practice Variation in Adherence to Guideline Recommendations for Secondary and Primary Prevention Among Outpatients With Atherothrombosis or Risk Factors in the United States2009 · 73 citations
  3. 3Postoperative levels of cardiac troponin versus CK-MB and high-sensitivity C-reactive protein for the prediction of 1-year cardiovascular outcome in patients undergoing vascular surgery2011 · 20 citations
  4. 4Use of Secondary Prevention Drug Therapy in Patients With Acute Coronary Syndrome After Hospital Discharge2008 · 122 citations
  5. 5A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease2009 · 904 citations