title: A pilot study using preoperative cerebral tissue oxygen saturation to stratify cardiovascular risk in major non-cardiac surgery.
abstract: This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65-70) versus unaffected, 71% (95% CI 70-72;P=0.04). No statistical difference was found between patients for new disability (range 70%-74%;P=0.73). Room air cerebral tissue oxygen saturation was significantly associated with major adverse events (odds ratio 1.36 (95% CI 1.03-1.79),P=0.03). Saturation levels ≤68% carried a positive likelihood ratio of 2.2 for death or severe morbidity,P=0.04. A definitive trial is required to confirm if cerebral oximetry can be used to stratify the cardiovascular risk of patients presenting for non-cardiac surgery.
authors.affiliation: Medical Student, South West Sydney Clinical School, University of NSW, Sydney, New South Wales.
authors.forename: Syb
authors.initials: S
authors.lastname: Wen
authors.affiliation: Medical Student, South West Sydney Clinical School, University of NSW, Sydney, New South Wales.
authors.forename: Azy
authors.initials: A
authors.lastname: Peng
authors.affiliation: Anaesthetic Registrar, Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales.
authors.forename: S
authors.initials: S
authors.lastname: Boyle
authors.affiliation: Anaesthetic Registrar, Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales.
authors.forename: S
authors.initials: S
authors.lastname: Cai
authors.affiliation: Trials Coordinator, Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales.
authors.forename: L
authors.initials: L
authors.lastname: Pope
authors.affiliation: Specialist Anaesthetist, Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales.
authors.forename: M T
authors.initials: MT
authors.lastname: Tran
authors.affiliation: Associate Professor, Department of Anaesthesia, Auckland City Hospital, New Zealand.
authors.forename: T G
authors.initials: TG
authors.lastname: Short
authors.affiliation: Associate Professor, Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales.
authors.forename: A
authors.initials: A
authors.lastname: Aneman
authors.affiliation: Associate Professor, South Western Sydney Clinical School, University of NSW, Sydney, New South Wales.
authors.forename: M
authors.initials: M
authors.lastname: Jaeger
authors.affiliation: Specialist Anaesthetist, Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales.
authors.forename: A
authors.initials: A
authors.lastname: Chuan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010100:Oxygen
keywords: near-infrared spectroscopy, outcomes assessment, postoperative complications, predictive value of tests