Association Between Heart Failure and Postoperative Mortality Among Patients Undergoing Ambulatory Noncardiac Surgery

Background: The decision whether to discontinue antiplatelet therapy in patients undergoing major noncardiac surgery can be clinically challenging. There is insufficient clinical evidence to establish comprehensive guidelines and most of recommendations are based on expert consensus. Objective: To evaluate the effectof withdrawal of antiplatelet therapy on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery. Age, gender, risk factors, previous chronic heart or lung disease, renal function, anemia and concomitant treatment were used in a binary logistic regression to determine the impact of withdrawal of antiplatelet therapy on prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: Five percent of patients presented the composite primary outcome measure of 30-day postoperative mortality or cardiovascular events. Antiplatelet therapy was withdrawn in 11.4% of patients (table). Discontinuation of antiplatelet therapy was associated with a significant increase in the primary outcome measure (OR 2.27; CI95%: 1.16-4.46). Conclusions: In a contemporary cohort of patients undergoing noncardiac surgery, withdrawal of antiplatelet therapy was associated with a worse short-term prognosis. There is an urgent need for further research in this field.

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Outcomes in heart failure patients after major noncardiac surgery

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2004.06.059 ◽

2004 ◽

Vol 44 (7) ◽

pp. 1446-1453 ◽

Cited By ~ 123

Author(s):

Adrian F. Hernandez ◽

David J. Whellan ◽

Sharon Stroud ◽

Jie Lena Sun ◽

Christopher M. O'Connor ◽

...

Keyword(s):

Heart Failure ◽

Noncardiac Surgery ◽

Heart Failure Patients

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Outcomes in heart failure patients after major noncardiac surgery

ACC Current Journal Review ◽

10.1016/j.accreview.2004.12.023 ◽

2005 ◽

Vol 14 (1) ◽

pp. 37

Author(s):

A.F. Hernandez ◽

D.J. Whellan ◽

S. Stroud ◽

J.L. Sun ◽

C.M. O’Connor ◽

...

Keyword(s):

Heart Failure ◽

Noncardiac Surgery ◽

Heart Failure Patients

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Near-Infrared Spectroscopy Monitoring in Cardiac and Noncardiac Surgery: Pairwise and Network Meta-Analyses

Journal of Clinical Medicine ◽

10.3390/jcm8122208 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2208 ◽

Cited By ~ 4

Author(s):

Christian Ortega-Loubon ◽

Francisco Herrera-Gómez ◽

Coralina Bernuy-Guevara ◽

Pablo Jorge-Monjas ◽

Carlos Ochoa-Sangrador ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Cardiovascular Events ◽

Near Infrared ◽

Postoperative Mortality ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Meta Analyses

Goal-directed therapy based on brain-oxygen saturation (bSo2) is controversial and hotly debated. While meta-analyses of aggregated data have shown no clinical benefit for brain near-infrared spectroscopy (NIRS)-based interventions after cardiac surgery, no network meta-analyses involving both major cardiac and noncardiac procedures have yet been undertaken. Randomized controlled trials involving NIRS monitoring in both major cardiac and noncardiac surgery were included. Aggregate-level data summary estimates of critical outcomes (postoperative cognitive decline (POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality) were obtained. NIRS was only associated with protection against POCD/POD in cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval (CI)/I2/number of studies (n): 0.34/0.14–0.85/75%/7), although a favorable effect was observed in the analysis, including both cardiac and noncardiac procedures. However, the benefit of the use of NIRS monitoring was undetectable in Bayesian network meta-analysis, although maintaining bSo2 > 80% of the baseline appeared to have the most pronounced impact. Evidence was imprecise regarding acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality. There is evidence that brain NIRS-based algorithms are effective in preventing POCD/POD in cardiac surgery, but not in major noncardiac surgery. However, the specific target bSo2 threshold has yet to be determined.

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