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Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery

KHETERPAL, Sachin ; O'REILLY, Michael ; ENGLESBE, Michael J ; ROSENBERG, Andrew L ; SHANKS, Amy M ; LINGLING ZHANG ; ROTHMAN, Edward D ; CAMPBELL, Darrell A ; TREMPER, Kevin K

Anesthesiology (Philadelphia), 2009, Vol.110 (1), p.58-66 [Periódico revisado por pares]

Hagerstown, MD: Lippincott Williams & Wilkins

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Título:
Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery
Autor: KHETERPAL, Sachin ; O'REILLY, Michael ; ENGLESBE, Michael J ; ROSENBERG, Andrew L ; SHANKS, Amy M ; LINGLING ZHANG ; ROTHMAN, Edward D ; CAMPBELL, Darrell A ; TREMPER, Kevin K
Assuntos: Adolescent ; Adult ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Female ; Heart Diseases - epidemiology ; Heart Diseases - etiology ; Heart Diseases - physiopathology ; Humans ; Intraoperative Complications - epidemiology ; Intraoperative Complications - etiology ; Intraoperative Complications - physiopathology ; Male ; Medical sciences ; Middle Aged ; Predictive Value of Tests ; Preoperative Care - trends ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative - adverse effects ; Urologic Surgical Procedures - adverse effects ; Vascular Surgical Procedures - adverse effects ; Young Adult
É parte de: Anesthesiology (Philadelphia), 2009, Vol.110 (1), p.58-66
Notas: ObjectType-Article-2
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Descrição: The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05). In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.
Editor: Hagerstown, MD: Lippincott Williams & Wilkins
Idioma: Inglês

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Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery

KHETERPAL, Sachin ; O'REILLY, Michael ; ENGLESBE, Michael J ; ROSENBERG, Andrew L ; SHANKS, Amy M ; LINGLING ZHANG ; ROTHMAN, Edward D ; CAMPBELL, Darrell A ; TREMPER, Kevin K

Hagerstown, MD: Lippincott Williams & Wilkins

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