Clinical study
Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay

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Abstract

Purpose

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 ≥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.

Conclusion

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.

Section snippets

Methods

Patients aged ≥50 years who underwent nonemergent major noncardiac surgery from January 1, 1990, to February 28, 1994, at Brigham and Women's Hospital were eligible for enrollment 2, 3, 11, 15, 16, 17, 18, 19, 20. Eligibility criteria also included the ability to speak English and adequate cognitive function for informed consent. Major noncardiac procedures included those that were either scheduled electively or performed nonemergently during inpatient admission with an expected length of stay

Results

The final cohort comprised 3970 patients. Patients with complications were more likely to be older and male, and to have hypertension, diabetes requiring insulin, or prior ischemic disease, heart failure, or cerebrovascular disease (Table 1). Creatine kinase samples were available in 3593 patients (91%).

Discussion

In this large prospective study of patients undergoing noncardiac surgery, cardiac and noncardiac complications were strongly correlated with each other. Although most studies have focused on the cardiac risk associated with noncardiac surgery and the morbidity associated with these complications 1, 2, 3, 4, 6, 7, relatively little is known about the relation of adverse cardiac outcomes to noncardiac complications. In a retrospective study of 2291 patients undergoing elective abdominal

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    Original funding for this study was provided by the Agency for Healthcare Research and Quality, Rockville, Maryland.

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