Intra-operative tachycardia and peri-operative outcome.
BACKGROUND
Intra-operative tachycardia is a common adverse event, often recorded as an indicator for process quality in quality assurance projects in anaesthesia.


METHODS
This retrospective study is based on data sets of 28,065 patients recorded with a computerised anaesthesia record-keeping system from 23 February 1999 to 31 December 2000 at a tertiary care university hospital. Cases were defined as patients with intra-operative tachycardia; references were automatically selected according to matching variables (high-risk surgery, severe congestive heart failure, severe coronary artery disease, significant carotid artery stenosis and/or history of stroke, renal failure, diabetes mellitus and urgency of surgery) in a stepwise fashion. Main outcome measures were hospital mortality, admission to the intensive care unit (ICU) and prolonged hospital stay. Differences in outcome measures between the matched pairs were assessed by univariate analysis. Stepwise regression models were developed to predict the impact of intra-operative tachycardia on the different outcome measures.


RESULTS
In our study 474 patients (1.7%) were found to have had intra-operative tachycardia. Matching was successful for 99.4% of the cases, leading to 471 cases and references. The crude mortality rates for the cases and matched references were 5.5% and 2.5%, respectively (P=0.020). Of all case patients, 22.3% were treated in an ICU, compared to 11.0% of the matched references (P=0.001). Hospital stay was prolonged in 25.1% of the patients with tachycardia compared to 15.1% of the matched references (P=0.001).


CONCLUSIONS
In this study, patients with intra-operative tachycardia who were undergoing non-cardiac surgery had a greater peri-operative risk, leading to increased mortality, greater frequency of admission to an ICU and prolonged hospital stay.
Hartmann
Bernd
B
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392 Giessen, Germany.
Junger
Axel
A
Röhrig
Rainer
R
Klasen
Joachim
J
Jost
Andreas
A
Benson
Matthias
M
Braun
Helge
H
Fuchs
Carsten
C
Hempelmann
Gunter
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013610:Tachycardia / Q000188:drug therapy / Q000453:epidemiology*
D000319:Adrenergic beta-Antagonists