Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay.
OBJECTIVE
To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery.


METHODS
We collected detailed information from the history, physical examination, and preoperative tests of 3970 patients aged > or =50 years who were undergoing major noncardiac procedures. Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively, and cardiac and noncardiac complications were recorded prospectively. Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications, and linear regression was used to assess their effects on length of stay.


RESULTS
Cardiac complications occurred in 84 patients (2%), and noncardiac complications developed in 510 patients (13%). Both types of complications occurred in 40 patients (1%). The most common cardiac complications were pulmonary edema (n = 42) and myocardial infarction (n = 41). The most common noncardiac complications were wound infection (n = 291), confusion (n = 87), respiratory failure requiring intubation (n = 62), deep venous thrombosis (n = 48), and bacterial pneumonia (n = 46). Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications, even after adjustment for preoperative clinical factors (odds ratio = 6.4; 95% confidence interval [CI]: 3.9 to 10.6). Mean length of stay was markedly increased in patients who experienced cardiac (11 days; 95% CI: 9 to 12 days) or noncardiac (11 days; 95% CI: 10 to 12 days) complications, or both (15 days; 95% CI: 12 to 18 days), as compared with patients without complications (4 days; 95% CI: 3 to 4 days), even after adjustment for procedure type and clinical factors.


CONCLUSIONS
Cardiac and noncardiac complications were strongly linked in patients undergoing noncardiac surgery. Patients who experienced one type of complication were at increased risk of developing the other type of complication as well as prolonged perioperative length of stay.
Department of Medicine, University of California, San Francisco 94143-0124, USA. fleischm@medicine.ucsf.edu
Kirsten E
KE
Fleischmann
Lee
L
Goldman
Belinda
B
Young
Thomas H
TH
Lee
D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology; D012307:Risk Factors