Abstract 11169: Factors Associated With Peri-operative Mortality, Myocardial Infarction, or Stroke in Patients Having Elective Vascular Surgery
Background: Multiple predictive tools, i.e. the Revised Cardiac Risk Index (RCRI), are widely used to assess risk of peri-operative cardiac events in non-cardiac elective surgeries. The application of such tools to a composite of poor outcomes in non-emergent vascular surgery is unclear. We sought to determine factors associated with peri-operative mortality, myocardial infarction (MI) or stroke in patients undergoing lower extremity bypass (LEB).
Methods: Patients who underwent LEB between 2005 and 2010 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQUIP) multi-center database. Baseline characteristics were identified, and the primary endpoint was defined as peri-operative mortality, myocardial infarction, or stroke. Chi-Square analyses identified univariate predictors and the difference in outcomes according to RCRI scores. Multivariate logistic regression with backward selection was used to determine the risk factors associated with the primary endpoint.
Results: Of 14,026 LEB patients, 6,479 (46.2%) were over the age of 70 and 8,806 (62.8%) were male. Over half (51.9%) underwent femoral-popliteal bypass. There were 294 (2.1%) patients with high cardiac risk (RCRI scores ≥ 3). Overall, 548 (3.9%) experienced the primary endpoint, for which there was increased risk in those with RCRI ≥ 3 compared to those without (OR 4.8, 95% CI 3.6-6.5; p<0.0001). In adjusted multivariate regression, the RCRI was an independent predictor (OR 3.6, 95% 2.5-5.0; p < 0.0001). Other risk factors included age > 70, high ASA class, functional dependence, prior cardiac surgery, diabetes, hypertension, COPD, and rest pain.
Conclusions: Patients undergoing LEB who have high RCRI scores experience more post-operative death, MI or stroke when compared to those with low RCRI scores. The RCRI and factors beyond baseline cardiac risk should be considered prior to non-emergent vascular surgeries.
- © 2013 by American Heart Association, Inc.