Abstract 15670: Implications of Surgical Parameters as Predictors of the Development of Postoperative Cardiac Events in Patients Undergoing Non-Cardiac Surgery
Objectives: Postoperative cardiac events are an important cause of morbidity and mortality in patients undergoing non-cardiac surgery. Predictive values of surgical parameters with respect to development of postoperative cardiac events have not been well investigated.
Methods and Results: This study included 1,016 consecutive patients who underwent cardiac consultation prior to elective non-cardiac surgery. Clinical risk factors and surgical data, including types of surgery and anesthesia, surgical times, need for transfusion during surgery, and postoperative hemoglobin level, were evaluated. A major adverse cardiac event (MACE) was defined as a composite of all cause death, non-fatal myocardial infarction, and pulmonary edema within 30 days of surgery. There were 95 (9.4%) postoperative MACEs. Patients with postoperative MACE were significantly older, and had significantly higher RCRI than those without. ST-T change on ECG was significantly higher in patients with postoperative MACE. Of the surgical parameters, significant differences in surgical times (317±211 min versus 189±112 min, P<0.001), postoperative hemoglobin (10.7±1.9 g/dl versus 11.3±1.8 g/dl, P=0.007), risk of surgery (P<0.001), and transfusion (37.6% versus 6.6%, P<0.001) were observed between the two groups. In multivariate logistic regression analysis, surgical time (odds ratio [OR] 1.004, 95% CI 1.003-1.006, P<0.001) and need for transfusion (OR 4.578, 95% CI 2.599-8.065, P<0.001), as well as age and ST-T change on ECG were independent predictors of postoperative MACE. In patients with a surgical time of ≥235 min, no significant differences in age, Revised Cardiac Risk Index (RCRI), ECG, and echocardiographic findings were observed between patients with and without postoperative MACE (Figure 1).
Conclusion: Surgical parameters, including surgical time and transfusion, can strongly predict development of postoperative MACE in patients undergoing non-cardiac surgery.
- © 2013 by American Heart Association, Inc.