Display options
Cite
Acheampong D, Guerrier S, Lavarias V, et al. Risk factors contributing to cardiac events following general and vascular surgery. Ann Med Surg (Lond). 2018;33:16-23doi: 10.1016/j.amsu.2018.08.001.
Acheampong, D., Guerrier, S., Lavarias, V., Pechman, D., Mills, C., Inabnet, W., Boateng, P., & Leitman, I. M. (2018). Risk factors contributing to cardiac events following general and vascular surgery. Annals of medicine and surgery (2012), 3316-23. https://doi.org/10.1016/j.amsu.2018.08.001
Acheampong, Derrick, et al. "Risk factors contributing to cardiac events following general and vascular surgery." Annals of medicine and surgery (2012) vol. 33 (2018): 16-23. doi: https://doi.org/10.1016/j.amsu.2018.08.001
Acheampong D, Guerrier S, Lavarias V, Pechman D, Mills C, Inabnet W, Boateng P, Leitman IM. Risk factors contributing to cardiac events following general and vascular surgery. Ann Med Surg (Lond). 2018 Aug 08;33:16-23. doi: 10.1016/j.amsu.2018.08.001. eCollection 2018 Sep. PMID: 30147870; PMCID: PMC6105747.
Copy Download .nbib Format: NLM
Share it on

Ann Med Surg (Lond). 2018 Aug 08;33:16-23. doi: 10.1016/j.amsu.2018.08.001. eCollection 2018 Sep.

Risk factors contributing to cardiac events following general and vascular surgery.

Annals of medicine and surgery (2012)

Derrick Acheampong, Shanice Guerrier, Valentina Lavarias, David Pechman, Christopher Mills, William Inabnet, Percy Boateng, I Michael Leitman

Affiliations

  1. Icahn School of Medicine at Mount Sinai, USA.

PMID: 30147870 PMCID: PMC6105747 DOI: 10.1016/j.amsu.2018.08.001

Abstract

BACKGROUND: Cardiac events (CE) following surgery have been associated with morbidity and mortality. Defining risk factors that contribute to CE is essential to improve surgical outcomes.

STUDY DESIGN: This was a retrospective study at a large urban teaching hospital for surgery performed from 2013 to 2015. Adult patients (≥18 years) that underwent general and vascular surgery were analyzed. Patients were grouped into those who experienced postoperative CE and those who did not. Univariate and multivariate regression analyses were used to identify predictors of postoperative CE, and association of CE with adverse postoperative outcomes. Separate subgroup analyses were also conducted for general and vascular surgery patients to assess predictors of CE.

RESULTS: Out of 8441 patients, 157 (1.9%) experienced CE after major general and vascular surgery. Underlying predictors for CE included age >65 years(OR 4.9, 95%CI 3.4-6.9,p < 0.01), ASA >3(OR 12.0, 95%CI 8.5-16.9,p < 0.01), emergency surgery(OR 3.7, 95%CI 2.7-5.1,p = 0.01), CHF(OR 11.2, 95%CI 6.4-16.7,p = 0.02), COPD(OR 3.9, 95%CI 2.4-6.4,p = 0.04), acute renal failure or dialysis(OR 8.0, 95%CI 5.2-12.1,p = 0.04), weight loss(OR 3.3, 95%CI 1.7-6.7,p < 0.01), preoperative creatinine >1.2 mg/dL(OR 5.1, 95%CI 3.7-7.1,p = 0.01), hematocrit <34%(OR 4.0, 95%CI 2.8-5.7,p < 0.01), and operative time >240 min(OR 2.0, 95%CI 1.3-3.3,p = 0.02). Following surgery, CE was associated with increased mortality(OR 3.5, 95%CI 1.2-6.5,p < 0.01), pulmonary complications(OR 5.0, 95%CI 3.1-8.9,p < 0.01), renal complications(OR 2.3, 95%CI 1.9-4.5,p < 0.01), neurologic complications(OR 2.5, 95%CI 1.4-5.2,p < 0.01), systemic sepsis(OR 2.2, 95%CI 1.7-4.0,p < 0.01), postoperative RBC transfusion(OR 4.4, 95%CI 2.7-6.5,p < 0.01), unplanned return to operating room(OR 4.0, 95%CI 2.3-6.9,p < 0.01), and prolonged hospitalization (OR 5.5, 95%CI 3.1-8.8,p = 0.03). There was no statistical difference in incidence of CE between general and vascular surgery patients (p = 0.44); however, predictors of CE differed between the two surgical groups.

CONCLUSION: Postoperative CE are associated with significant morbidity and mortality. Identified predictors of CE should allow for adequate risk stratification and optimization of perioperative surgical management.

Keywords: CE, cardiac events; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; Cardiac events; General surgery; MI, myocardial infarction; Noncardiac surgery; Risk factors; Vascular surgery

References

  1. Ann Intern Med. 2000 Sep 5;133(5):356-9 - PubMed
  2. J Gen Intern Med. 1986 Jul-Aug;1(4):211-9 - PubMed
  3. Am J Med. 2005 Oct;118(10):1134-41 - PubMed
  4. JAMA. 2007 Jun 13;297(22):2481-8 - PubMed
  5. J Gen Intern Med. 2001 Aug;16(8):507-18 - PubMed
  6. CMAJ. 2005 Sep 13;173(6):627-34 - PubMed
  7. Eur Heart J. 1987 Feb;8(2):179-85 - PubMed
  8. Circulation. 1999 Sep 7;100(10):1043-9 - PubMed
  9. Lancet. 2011 Oct 15;378(9800):1396-407 - PubMed
  10. Med Clin North Am. 2009 Sep;93(5):1095-104 - PubMed
  11. Rev Esp Cardiol. 2006 Apr;59(4):329-37 - PubMed
  12. J Am Coll Cardiol. 2000 Sep;36(3):959-69 - PubMed
  13. Heart. 2006 Dec;92(12):1866-72 - PubMed
  14. J Am Coll Surg. 2007 Jun;204(6):1199-210 - PubMed
  15. Anesthesiology. 2009 Jan;110(1):58-66 - PubMed
  16. Int J Surg. 2017 Oct;46:198-202 - PubMed
  17. J Am Coll Surg. 2004 Oct;199(4):531-7 - PubMed
  18. N Engl J Med. 1977 Oct 20;297(16):845-50 - PubMed
  19. Spine (Phila Pa 1976). 2014 Aug 1;39(17):1441-8 - PubMed
  20. Anesthesiology. 2003 Aug;99(2):259-69 - PubMed
  21. Anesthesiology. 2009 Mar;110(3):574-81 - PubMed
  22. Anaesthesia. 2003 Oct;58(10):985-91 - PubMed

Publication Types