Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study.
BACKGROUND
Right heart catheterization (RHC) is commonly performed before high-risk noncardiac surgery, but the benefit of this strategy remains unproven.


OBJECTIVE
To evaluate the relationship between use of perioperative RHC and postoperative cardiac complication rates in patients undergoing major noncardiac surgery.


METHODS
Prospective, observational cohort study.


METHODS
Tertiary care teaching hospital in the United States.


METHODS
Patients (n = 4059 aged >/=50 years) who underwent major elective noncardiac procedures with an expected length of stay of 2 or more days between July 18, 1989, and February 28, 1994. Two hundred twenty one patients had RHC and 3838 did not.


METHODS
Combined end point of major postoperative cardiac events, including myocardial infarction, unstable angina, cardiogenic pulmonary edema, ventricular fibrillation, documented ventricular tachycardia or primary cardiac arrest, and sustained complete heart block, classified by a reviewer blinded to preoperative data.


RESULTS
Major cardiac events occurred in 171 patients (4.2%). Patients who underwent perioperative RHC had a 3-fold increase in incidence of major postoperative cardiac events (34 [15.4%] vs 137 [3.6%]; P<.001). In multivariate analyses, the adjusted odds ratios (ORs) for postoperative major cardiac and noncardiac events in patients undergoing RHC were 2.0 (95% confidence interval [CI], 1.3-3.2) and 2.1 (95% CI, 1.2-3.5), respectively. In a case-control analysis of a subset of 215 matched pairs of patients who did and did not undergo RHC, adjusted for propensity of RHC and type of procedure, patients who underwent perioperative RHC also had increased risk of postoperative congestive heart failure (OR, 2.9; 95% CI, 1.4-6.2) and major noncardiac events (OR, 2.2; 95% CI, 1.4-4.9).


CONCLUSIONS
No evidence was found of reduction in complication rates associated with use of perioperative RHC in this population. Because of the morbidity and the high costs associated with RHC, the impact of this intervention in perioperative care should be evaluated in randomized trials.
Polanczyk
C A
CA
Partners Community HealthCare Inc, Suite 1150, Prudential Tower, 800 Boylston St, Boston, MA 02199, USA. thlee@partners.org
Rohde
L E
LE
Goldman
L
L
Cook
E F
EF
Thomas
E J
EJ
Marcantonio
E R
ER
Mangione
C M
CM
Lee
T H
TH
D000368:Aged; D016022:Case-Control Studies; D002407:Catheterization, Swan-Ganz; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012306:Risk