Clinical studyAssociation between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on 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
References (31)
- et al.
The association of intraoperative factors with the development of postoperative delirium
Am J Med
(1998) - et al.
Risk of pulmonary complications after elective abdominal surgery
Chest
(1996) - et al.
Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery
Am J Cardiol
(2001) - et al.
Prognostic value of cardiac troponin T after noncardiac surgery6-month follow-up data
J Am Coll Cardiol
(1997) - et al.
Body mass index as a correlate of postoperative complications and resource utilization
Am J Med
(1997) - et al.
Pulmonary risk factors of elective abdominal aortic surgery
J Vasc Surg
(1993) - et al.
ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summarya report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
J Am Coll Cardiol
(2002) - et al.
Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery
Am J Surg
(1989) Surgical wound infection occurrence in clean operations; risk stratification for interhospital comparisons
Am J Med
(1981)- et al.
Multifactorial index of cardiac risk in noncardiac surgical procedures
N Engl J Med
(1977)
Derivation and prospective validation of simple index for prediction of cardiac risk of major noncardiac surgery
Circulation
Predictive value of creatine kinase (CK)-MB for diagnosis of acute myocardial infarction after major noncardiac surgery
Arch Med Res
Cardiac risk of noncardiac surgeryinfluence of coronary disease and type of surgery in 3368 operations
Circulation
Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery
J Gen Intern Med
Myocardial infarction after noncardiac surgery
Anesthesiology
Cited by (164)
Post-Operative Outcomes of Pre-Thoracic Surgery Respiratory Muscle Training vs Aerobic Exercise Training: A Systematic Review and Network Meta-analysis
2023, Archives of Physical Medicine and RehabilitationAssociation of preoperative smoking with complications following major gastrointestinal surgery
2022, American Journal of SurgeryAssociation of preoperative spirometry with cardiopulmonary fitness and postoperative outcomes in surgical patients: A multicentre prospective cohort study
2020, EClinicalMedicineCitation Excerpt :Unlike FEV1, cardiopulmonary fitness appears to be an important preoperative determinant of risk for postoperative pulmonary complications. Worldwide, about 300 million people have major surgery every year.1–3 Following in-patient surgery, postoperative respiratory complications are common, occurring in up to 10% of patients, and important, owing to their association with increased mortality, hospital length-of-stay, and health care resource utilisation.
Measuring and monitoring cognition in the postoperative period
2020, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :It provides an opportunity to look at individual differences in cognition a response to surgery. As most surgical patients are discharged within one week [67], it is recommended that tests are re-administered prior to discharge; this is likely to be a point at which there is a reasonable expectation that most patients are beginning to resume many usual routines and activities. Tests at this time should consider the potential effects of post-surgical pain, sleep disturbance, fatigue, nausea, and the effects of opioid and sedative medications, which may not be entirely resolved by discharge and may increase the risk of ‘false positives’ [68].
Early cardiac complications after bariatric surgery: does the type of procedure matter?
2019, Surgery for Obesity and Related Diseases
- ☆
Original funding for this study was provided by the Agency for Healthcare Research and Quality, Rockville, Maryland.