The impact of previous or concomitant myocardium revascularization on the outcomes of patients undergoing major non-cardiac surgery.
The aim of this study was to analyze the results of major non-cardiac surgery in patients with severe coronary arterial disease who underwent concomitant vs. previous myocardial revascularization (MR) in terms of operative complications and hospital stay. Between June 1999 and October 2008, 37 patients with coronary arterial disease underwent neoplastic resection at our hospital. Fourteen patients with a curable left-main or multiple-vessel disease received surgical MR concomitantly, while 23 patients previously underwent surgical or transluminal MR. Univariate analysis determined the impact of the timing of MR on operative complications and hospital stay. The overall mortality and morbidity rates were 3% and 65%, respectively. Compared with simultaneous MR, neoplastic surgery with previous MR had shorter postoperative hospital stay. Occurrence of postoperative complications was influenced by surgical duration (P=0.014). Postoperative length of hospital stay was affected by the timing of revascularization (P=0.008) and surgical duration (P=0.007). Previous MR can shorten postoperative hospital length of stay for current major non-cardiac surgeries in patients with severe coronary artery disease (CAD). For patients with concomitant severe CAD and clinically rapidly progressive malignant neoplasm, simultaneous neoplastic resection and MR is associated with acceptable operative mortality.
Zhang
Hong
H
Department of Anaesthesia and Critical Care Medicine, Peking University First Hospital, Beijing, China. zhanghong40@hotmail.com
Wang
Dong-xin
DX
Xiao
Feng
F
Li
Jian
J
He
Zhi-song
ZS
Wan
Yuan-lian
YL
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000401:mortality; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome