scholarly journals Perioperative Cardiovascular Considerations Prior to Elective Noncardiac Surgery in Patients With a History of COVID-19

JAMA Surgery ◽  
2022 ◽  
Author(s):  
Nidhi Rohatgi ◽  
Nathaniel R. Smilowitz ◽  
Risheen Reejhsinghani
Keyword(s):  
Noncardiac Surgery ◽  
History Of

scholarly journals Clinical Outcome of Noncardiac Surgery in Patients With History of Coronary Artery Revascularization by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

2018 ◽  
Vol 9 ◽  
pp. 117967071774894
Author(s):  
Jungchan Park ◽  
Seung Hwa Lee ◽  
Jeayoun Kim ◽  
Myungsoo Park ◽  
Hyeon-Cheol Gwon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcome ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Noncardiac Surgery ◽  
Percutaneous Coronary ◽  
History Of

Objective: Although safety concerns still remain among patients undergoing unanticipated noncardiac surgery after prior percutaneous coronary intervention (PCI), it has not been directly compared with coronary artery bypass grafting (CABG). The objective of this study was to compare clinical outcomes after noncardiac surgery in patients with prior (>6 months) coronary revascularization by PCI or CABG. Methods: From February 2010 to December 2015, 413 patients with a history of coronary revascularization, scheduled for noncardiac surgery were identified. Patients were divided into PCI group and CABG group and postoperative clinical outcome was compared between 2 groups. The primary outcome was composite of all-cause death, myocardial infarction, and stroke in 1-year follow-up. Results: The 413 patients were divided according to prior coronary revascularization types: 236 (57.1%) into PCI and 177 (42.9%) into CABG group. In multivariate analysis within 1-year follow-up, there was no significant difference in clinical outcome which was composite of all-cause death, myocardial infarction, and stroke (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 0.76-2.93; P = .24). The same result was present in propensity-matched population analysis (HR: 1.43; 95% CI: 0.68-3.0; P = .34). Conclusions: In patients undergoing noncardiac surgery with prior coronary revascularization by PCI or CABG performed on an average of 42 months after PCI and 50 months after CABG, postoperative clinical outcome at 1-year follow-up is comparable.

The “Natural History” of Segmental Wall Motion Abnormalities in Patients Undergoing Noncardiac Surgery

1990 ◽  
Vol 73 (4) ◽  
pp. 644-655 ◽  
Author(s):  
Martin J. London ◽  
Julio F. Tubau ◽  
Martin G. Wong ◽  
Elizabeth Layug ◽  
Milton Hollenberg ◽  
...  
Keyword(s):  
Natural History ◽  
Wall Motion ◽  
Noncardiac Surgery ◽  
Segmental Wall Motion ◽  
Segmental Wall ◽  
History Of ◽  
Wall Motion Abnormalities

Delayed Bilateral Pneumothorax after Subclavian Vein Catheterization

1995 ◽  
Vol 10 (5) ◽  
pp. 261-263 ◽  
Author(s):  
John M. Oropello ◽  
Andrew Leibowitz ◽  
Pedro Sepulveda ◽  
Henry Kuerer ◽  
Ernest Benjamin
Keyword(s):  
Subclavian Vein ◽  
Historical Data ◽  
Median Sternotomy ◽  
Noncardiac Surgery ◽  
Tube Thoracostomy ◽  
Bilateral Pneumothorax ◽  
Left Subclavian Vein ◽  
History Of ◽  
Vein Catheterization

A delayed bilateral pneumothorax complicated unilateral left subclavian vein catheterization and required treatment with tube thoracostomy. This case is unique in the demonstration that bilateral pneumothorax can present in a delayed fashion, and that, as a result of a previously formed pleuropleural fistula, it can occur in patients with a history of noncardiac surgery involving median sternotomy. Historical data on delayed pneumothoraces and bilateral pneumothoraces are presented.

scholarly journals Current multivariate risk scores in patients undergoing non-cardiac surgery

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Gian Francesco Mureddu
Keyword(s):  
Risk Index ◽  
External Validation ◽  
Noncardiac Surgery ◽  
Risk Scores ◽  
Cardiac Complications ◽  
Vascular Events ◽  
Improvement Program ◽  
Discharge Data ◽  
C Statistic ◽  
History Of

<p class="p1">Several indexes to predict perioperative cardiovascular risk have been proposed overtime. The most widely used is the Revised Cardiac Risk Index (RCRI) developed by Lee since 1999. It predicts major cardiac outcomes from five independent clinical determinants: history of ischemic heart disease, history of cardiovascular disease, heart failure, insulin-dependent diabetes mellitus, and chronic renal failure (<em>i.e.</em> serum creatinine &gt;2 mg/dl). In external validation studies, the RCRI showed high negative predictive value in all groups of age, indicating that it may be used to identify people at low risk for perioperative adverse cardiovascular events in noncardiac surgery. However its accuracy is suboptimal in many clinical settings. More recently the National Surgical Quality Improvement Program database) (NSQIP) hasdeveloped a new index to predict perioperative myocardial infarction (MI) or cardiac arrest (MICA) from a cohort of 211,410 patients (the Gupta index) and afterwards a universal surgical risk estimation tool has been developed, using standardized clinical data from 393 ACSNSQIP hospitals in US (a cohort based on 1,414,006 patients), showing a good performance for mortality (C-statistic = 0.944) and morbidity (C-statistic =0.816) as compared with procedure-specific models. Other risk scores include the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION), which has evaluated cardiac complications in 15,065 patients, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and the large Preoperative Score to Predict Postoperative Mortality (POSPOM) that was built up from data collected in the National Hospital Discharge Data Base (NHDBB) including a cohort of 7.059.447 patients. In Italy a new risk index (the Orion score) builkt up from a cohort of 9000 patients generated four classes of major cardiovascular adverse events perioperative risk ranging from 1 (0.6%); 2 (2.4%); 3 (7.4%) and 4 (23.1%). The AUROC curves showed higher accuracy as compared to the RCRI score both in the derivation than in the validation cohort (AUROC= 0.872 ± 0.028 <em>vs</em> 0.807 ± 0.037). Thus, many risk indices are available nowadays. Despite the latest European guidelines recommended them for risk stratification (class I, level of evidence B), their use in clinical practice is still scarce.</p>

Acute Stroke

2017 ◽  
Author(s):  
Laurel E. Moore
Keyword(s):  
Neurological Disorders ◽  
Postoperative Morbidity ◽  
Elective Surgery ◽  
The United States ◽  
Noncardiac Surgery ◽  
Perioperative Stroke ◽  
Systemic Thrombolysis ◽  
Central Focus ◽  
Improved Outcomes ◽  
History Of

Stroke is the leading cause of disability in the United States, and in terms of mortality is second only to ischemic heart disease worldwide. Medical management for acute ischemic stroke (AIS) was limited to supportive care until 1995, when the National Institute of Neurological Disorders and Stroke (NINDS) trial demonstrated improved outcomes with systemic thrombolysis for AIS. Since December 2014, four major articles have been published in support of endovascular intervention for AIS, making this a central focus of this chapter. Other related topics for this chapter include the timing of elective surgery following stroke, how to assess perioperative risk for patients having a history of remote stroke, and implications for postoperative morbidity and mortality associated with perioperative stroke in noncardiac surgery.

Risk Assessment Before Noncardiac Surgery

2015 ◽  
Author(s):  
Wael AlJaroudi
Keyword(s):  
Risk Assessment ◽  
Preoperative Evaluation ◽  
A Priori ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Therapeutic Interventions ◽  
Increased Risk ◽  
History Of ◽  
Optimal Approach

Perioperative risk assessment is essential in screening patients before noncardiac surgery. Cardiovascular complications such as fatal and non-fatal myocardial infarction (MI), ventricular arrhythmia, pulmonary edema, and stroke are important in-hospital causes of morbidity and mortality intra and post-operatively. The optimal approach is to identify patients at increased risk so that appropriate testing and therapeutic interventions are undertaken a priori to minimize such risk. The initial preoperative evaluation includes identification of surgery-specific risk, patient exercise functional capacity and clinical risk profile. Patients with major predictors of events such as acute coronary syndromes, recent MI, unstable arrhythmia, and severe valvular disease warrant further management and optimization that often lead to delaying surgery. Those with three or more predictors (history of ischemic heart disease, compensated heart failure, diabetes, renal insufficiency, or history of cerebrovascular disease) undergoing high- risk surgery often require stress testing. Although data from randomized prospective trials are lacking, numerous studies have demonstrated the utility of myocardial perfusion imaging (MPI) for determination of perioperative cardiac risk. The goal of this chapter is to review the use of MPI for preoperative risk assessment and the recommendations from the current guidelines. The focus will be on short-term and long-term prognosis including special groups such as after coronary stenting and before vascular surgery, liver and renal transplantation.

Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

2021 ◽  
Vol 135 (4) ◽  
pp. 711-723
Author(s):  
James S. Khan ◽  
Daniel I. Sessler ◽  
Matthew T. V. Chan ◽  
C. Y. Wang ◽  
Ignacio Garutti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Rating Scale ◽  
Noncardiac Surgery ◽  
Persistent Pain ◽  
Increased Risk ◽  
History Of ◽  
Incisional Pain

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P &lt; 0.001), surgery for fracture (P &lt; 0.001), history of chronic pain (P &lt; 0.001), coronary artery disease (P &lt; 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P &lt; 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P &lt; 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P &lt; 0.001, respectively). Older age (P &lt; 0.001), endoscopic surgery (P = 0.005), and South Asian (P &lt; 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P &lt; 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Perioperative Morbidity and Mortality after Noncardiac Surgery in Young Adults with Congenital or Early Acquired Heart Disease: A Retrospective Cohort Analysis of the National Surgical Quality Improvement Program Database

2014 ◽  
Vol 80 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Bryan G. Maxwell ◽  
Jim K. Wong ◽  
Robert L. Lobato
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Noncardiac Surgery ◽  
Study Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Perioperative Morbidity ◽  
History Of

An increasing number of patients with congenital heart disease survive to adulthood. Expert opinion suggests that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Using the National Surgical Quality Improvement Program database, we identified a cohort of patients aged 18 to 39 years with prior heart surgery who underwent noncardiac surgery between 2005 and 2010. A comparison cohort with no prior cardiovascular surgery was matched on age, sex, race/ethnicity, operation year, American Society of Anesthesiologists physical status, and Current Procedural Terminology code. A study cohort consisting of 1191 patients was compared with a cohort of 5127 patients. Baseline dyspnea, inpatient status at the time of surgery, and a prior operation within 30 days were more common in the study cohort. Postoperative outcomes were less favorable in the study cohort. Observed rates of death, peri-operative cardiac arrest, myocardial infarction, stroke, respiratory complications, renal failure, sepsis, venous thromboembolism, perioperative transfusion, and reoperation were significantly higher in the study cohort ( P < 0.01 for all). Mean postoperative length of stay was greater in the study cohort (5.8 vs 3.6 days, P < 0.01). Compared with a matched control cohort, young adult patients with a history of prior cardiac surgery experienced significantly greater perioperative morbidity and mortality after noncardiac surgery. A history of prior cardiac surgery represents a marker of substantial perioperative risk in this young population that is not accounted for by the matched variables. These results suggest that adult patients with congenital heart disease are at risk for adverse outcomes and support the need for further registry-based investigations.

74Subclinical atrial fibrillation before and after acute medical illness or noncardiac surgery: insights from ASSERT

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
W Mcintyre ◽  
J Wang ◽  
S J Connolly ◽  
A P Benz ◽  
D Conen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Noncardiac Surgery ◽  
Medical Illness ◽  
Atrial Rate ◽  
The Past ◽  
Significant Difference ◽  
Before And After ◽  
History Of

Abstract OnBehalf ASSERT Investigators Background Atrial fibrillation (AF) is frequently detected perioperatively or during acute medical illness. It is unclear if such AF is reversible and unlikely to recur, or is a manifestation of paroxysmal AF. Objective To compare the prevalence of pacemaker-detected, subclinical AF (atrial rate &gt;190 bpm) before and after hospitalization for noncardiac surgery or medical illness in patients without a history of clinical AF. Methods ASSERT enrolled patients who were &gt;65 years old and had hypertension but no known AF. Pacemakers and defibrillators recorded episodes of subclinical AF. We identified participants who were hospitalized for noncardiac surgery or medical illness, and created heart rhythm profiles, centred on the day of hospitalization. We compared the prevalence of subclinical AF before and after hospitalization. We blanked the 30 days before hospitalization, because of uncertainty in defining the precise onset of illness. Results Among 2580 patients, 436 had a documented surgical or medical hospitalization. In the 30 days following a first hospitalization, 43 patients (9.9%) had &gt;1 episode of &gt;6 minutes of subclinical AF; 20 (4.6%) had &gt;6 hours and 13 (3%) had &gt;24 hours. A higher proportion of patients had &gt;1 episode of subclinical AF &gt;6 minutes in the 30 days following a first surgical or medical hospitalization, as compared to the period between 30 and 60 days before hospitalization (9.9% versus 4.4%, P &lt; 0.001). There was no significant difference when comparing 0-90 days after hospitalization to 30-120 days before (13.7% versus 10.6%, P = 0.1). Similar results were observed for the same comparisons with episodes &gt;6 hours (4.6% versus 2.3%, P = 0.03 and 5.9% versus 5.6%, P = 0.8, respectively). The majority of patients with subclinical AF in the 30 days following hospitalization had at least one episode of subclinical AF of the same duration in the 6 months prior (50% for episodes &gt;6 minutes; 69% for &gt;6 hours and 60% for &gt;24 hours). Those who did have subclinical AF in the 30 days following hospitalization were more likely to have had subclinical AF in the past 6 months than those who did not (OR 7.2 95%CI 3.2-15.8 for episodes &gt;6 minutes; OR 32.6, 95%CI 10.3-103.4 for &gt;6 hours and OR 36.3 95%CI 9.0-146.0 for &gt;24 hours). Conclusions The prevalence of subclinical AF increased following hospitalization for noncardiac surgery or medical illness.  However, most patients with subclinical AF following hospitalization had previously experienced similar episodes, particularly those with longer episodes of subclinical AF.

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