Incidence, Predictors and Risk Scores to Predict Postoperative Mortality After Vascular 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 Antiplatelet therapy was withdrawn in 11.4% of patients (table).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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Commentary on ‘Incidence, predictors and validation of risk scores to predict postoperative mortality after noncardiac vascular surgery, a prospective cohort study’

International Journal of Surgery ◽

10.1016/j.ijsu.2020.01.144 ◽

2020 ◽

Vol 75 ◽

pp. 80-81

Author(s):

Erkan İriz

Keyword(s):

Cohort Study ◽

Vascular Surgery ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Mortality ◽

Risk Scores

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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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Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery: Erratum

Anesthesiology ◽

10.1097/01.anes.0000479922.33134.89 ◽

2016 ◽

Vol 124 (3) ◽

pp. 741-742

Keyword(s):

Postoperative Mortality ◽

Noncardiac Surgery ◽

Intraoperative Hypotension

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

JAMA Surgery ◽

10.1001/jamasurg.2019.2110 ◽

2019 ◽

Vol 154 (10) ◽

pp. 907 ◽

Cited By ~ 2

Author(s):

Benjamin J. Lerman ◽

Rita A. Popat ◽

Themistocles L. Assimes ◽

Paul A. Heidenreich ◽

Sherry M. Wren

Keyword(s):

Heart Failure ◽

Postoperative Mortality ◽

Noncardiac Surgery

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Faculty Opinions recommendation of Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population-Based Cohort Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726091608.793513814 ◽

2016 ◽

Author(s):

Davide Cattano

Keyword(s):

Cohort Study ◽

Postoperative Mortality ◽

Population Based ◽

Noncardiac Surgery

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Medical Evaluation of the Surgical Patient (SAGHE)

10.2310/gastro.1086 ◽

2014 ◽

Author(s):

Marie Gerhard-Herman ◽

Jonathan Gates

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Stress Test ◽

Risk Index ◽

Fluid Management ◽

Postoperative Mortality ◽

Noncardiac Surgery ◽

Surgical Patient ◽

Improvement Program ◽

Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This review contains 3 highly rendered figures, 12 tables, and 68 references.

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Abstract 17765: Mild Preoperative Anemia is an Independent Predictor of Mortality and Cardiovascular Events in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽

10.1161/circ.130.suppl_2.17765 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jesús álvarez-García ◽

Miquel Vives-Borrás ◽

Joan I Llao ◽

Andreu Ferrero-Gregori ◽

Marc Bausili ◽

...

Keyword(s):

Risk Factor ◽

Cardiovascular Events ◽

Postoperative Mortality ◽

Postoperative Outcome ◽

Primary Outcome Measure ◽

Noncardiac Surgery ◽

Concomitant Treatment ◽

Preoperative Anemia ◽

Increased Risk ◽

The Impact

Background: Preoperative anemia has been recognized as an important risk factor for perioperative red blood cell transfusions and adverse events in patients undergoing noncardiac surgery. Mild anemia has not unequivocally shown to be a risk factor for death, unless cardiac disease is present or major blood loss occurs. Objective: To evaluate the prevalence of preoperative anemia and its effect 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.Based on preoperative hemoglobin levels and gender, we stratified patients into the next categories of anemia: mild (11-12 g/dl), moderate (10-11 g/dl) and severe (<10 g/dl) for female; mild (12-13 g/dl), moderate (11-12 g/dl) and severe (<11 g/dl) for male. Age, risk factors, previous chronic heart or lung disease, renal function and concomitant treatment were used in a binary logistic regression to determine the impact of anemia in 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: The overall prevalence of anemia was 18.8%. Thirty-day mortality and cardiac event rate increased with the presence of anemia (table). Mild, moderate and severe anemia were associated with a two-fold (OR 2.07; CI 95%: 1.04-4.11), three-fold (OR 2.93; CI 95%: 1.45-5.94) and four-fold (OR 4.09; CI 95%:1.87-8.95) increases in the risk of MACCE respectively. Conclusions: Anemia is a prevalent risk factor in patients undergoing major noncardiac surgery. Even mild degrees of preoperative anemia are associated with an increased risk of 30-day postoperative mortality and cardiovascular events. Further studies are needed in order to evaluate whether treatment of preoperative anemia could reduce postoperative mortality.

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