Having two or more risk factors (hypertension, limited activity, reduced renal function) was associated with a 20% in-hospital mortality rate, nearly eight times higher than having one or none.
Cohort (n=474)
No
What are the causes of and risk factors for in-hospital and long-term mortality in male veterans with or at high risk for coronary artery disease following major noncardiac surgery?
In male veterans with or at high risk for coronary artery disease undergoing major noncardiac surgery, noncardiac causes of death are more common than cardiac causes, and specific risk factors strongly predict in-hospital mortality.
Relative Risk: 8 (95% CI 3.6–16)
Objectives. —To determine the causes of and risk factors for mortality following noncardiac surgery. Design. —Prospective cohort study. Setting. —A university-affiliated Veterans Affairs medical center. Patients. —Consecutive series of 474 men between the ages of 38 and 89 years (mean age, 68 years) who were undergoing major noncardiac surgery involving general anesthesia. All subjects had known coronary artery disease or were at high risk for coronary artery disease. Measurements and Results. —During the initial hospitalization, 26 patients (5%) died, most commonly from sepsis (n=6) or cardiac diseases (n=6). Deaths occurred from postoperative days 2 to 69; half occurred more than 3 weeks after surgery. Multivariable analysis disclosed that a history of hypertension (odds ratio OR=3.8; 95% confidence interval Cl, 1.1 to 13), a severely limited activity level (OR=9.7; 95% Cl, 2.5 to 37), and a creatinine clearance of less than 0.83 mL/s (OR=6.8; 95% Cl, 2.8 to 16) were all independently associated with an increased risk of postoperative mortality. The mortality rate in patients with two or more of these risk factors was 20%, nearly eight times higher (95% Cl, 3.6 to 16) than those with one or no risk factors. An additional 82 patients died within the next 2 years; cancer, renal dysfunction, congestive heart failure, and obstructive pulmonary disease were independently associated with long-term mortality. Conclusions. —Even in patients at high risk of cardiac complications following surgery, noncardiac causes of death are more common. Patients with a history of hypertension, severely limited activity, and reduced renal function appear to be at especially high risk of in-hospital mortality after noncardiac surgery. (JAMA. 1992;268:228-232)
Warren S. Browner (Wed,) conducted a cohort in Major noncardiac surgery in patients with or at high risk for coronary artery disease (n=474). Two or more risk factors (hypertension, severely limited activity, creatinine clearance <0.83 mL/s) vs. One or no risk factors was evaluated on In-hospital mortality (RR 8.0, 95% CI 3.6-16). Having two or more risk factors (hypertension, limited activity, reduced renal function) was associated with a 20% in-hospital mortality rate, nearly eight times higher than having one or none.