Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery.
BACKGROUND
The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data.


METHODS
The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days.


RESULTS
Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05).


CONCLUSIONS
In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.
Kheterpal
Sachin
S
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA. sachinkh@med.umich.edu
O'Reilly
Michael
M
Englesbe
Michael J
MJ
Rosenberg
Andrew L
AL
Shanks
Amy M
AM
Zhang
Lingling
L
Rothman
Edward D
ED
Campbell
Darrell A
DA
Tremper
Kevin K
KK
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult