Prediction of perioperative cardiac complications in patients with proximal femoral fracture

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications.

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Faculty Opinions recommendation of The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients.

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

10.3410/f.13437044.14811178 ◽

2012 ◽

Author(s):

Mitchell Tsai ◽

Jessica Heath

Keyword(s):

Vascular Surgery ◽

New England ◽

Risk Index ◽

Cardiac Risk ◽

Cardiac Complications ◽

Study Group ◽

Cardiac Risk Index

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The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.03.031 ◽

2010 ◽

Vol 52 (3) ◽

pp. 674-683.e3 ◽

Cited By ~ 123

Author(s):

Daniel J. Bertges ◽

Philip P. Goodney ◽

Yuanyuan Zhao ◽

Andres Schanzer ◽

Brian W. Nolan ◽

...

Keyword(s):

Vascular Surgery ◽

New England ◽

Risk Index ◽

Cardiac Risk ◽

Cardiac Complications ◽

Study Group ◽

Cardiac Risk Index

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External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study

BMJ Open ◽

10.1136/bmjopen-2016-013510 ◽

2017 ◽

Vol 7 (1) ◽

pp. e013510 ◽

Cited By ~ 12

Author(s):

Pavel S Roshanov ◽

Michael Walsh ◽

P J Devereaux ◽

S Danielle MacNeil ◽

Ngan N Lam ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Index ◽

External Validation ◽

Cardiac Risk ◽

Cardiac Complications ◽

Cardiac Risk Index

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The Influence of Aging on the Prognostic Value of the Revised Cardiac Risk Index for Postoperative Cardiac Complications in Vascular Surgery Patients

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2007.05.002 ◽

2007 ◽

Vol 34 (6) ◽

pp. 632-638 ◽

Cited By ~ 36

Author(s):

G.M.J.M. Welten ◽

O. Schouten ◽

R.T. van Domburg ◽

H.H.H. Feringa ◽

S.E. Hoeks ◽

...

Keyword(s):

Vascular Surgery ◽

Prognostic Value ◽

Risk Index ◽

Cardiac Risk ◽

Cardiac Complications ◽

Cardiac Risk Index

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External Validation of the Recalibrated Thoracic Revised Cardiac Risk Index for Predicting the Risk of Major Cardiac Complications After Lung Resection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.03.095 ◽

2011 ◽

Vol 92 (2) ◽

pp. 445-448 ◽

Cited By ~ 37

Author(s):

Alessandro Brunelli ◽

Stephen D. Cassivi ◽

Juan Fibla ◽

Lisa A. Halgren ◽

Dennis A. Wigle ◽

...

Keyword(s):

Risk Index ◽

Lung Resection ◽

External Validation ◽

Cardiac Risk ◽

Cardiac Complications ◽

Cardiac Risk Index

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Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024661 ◽

2021 ◽

pp. 0310057X2110246

Author(s):

Yao Yao ◽

Ashok Dharmalingam ◽

Cyril Tang ◽

Harrison Bell ◽

Andrew DJ McKeown ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Index ◽

Cardiac Risk ◽

Tertiary Hospital ◽

Major Adverse Cardiac Events ◽

Cardiac Complications ◽

Cardiac Events ◽

Prognostic Accuracy ◽

Cardiac Risk Index ◽

Adverse Cardiac Events

Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.

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