| Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. | |
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MedLine Citation:
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PMID: 19104171 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. METHODS: The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. RESULTS: Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05). CONCLUSIONS: In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery. |
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Authors:
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Sachin Kheterpal; Michael O'Reilly; Michael J Englesbe; Andrew L Rosenberg; Amy M Shanks; Lingling Zhang; Edward D Rothman; Darrell A Campbell; Kevin K Tremper |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 110 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-23 Completed Date: 2009-01-22 Revised Date: 2009-07-28 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 58-66 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA. sachinkh@med.umich.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Female Heart Diseases / epidemiology, etiology*, physiopathology Humans Intraoperative Complications / epidemiology, etiology*, physiopathology Male Middle Aged Predictive Value of Tests Preoperative Care* / trends Prospective Studies Risk Factors Surgical Procedures, Operative / adverse effects Urologic Surgical Procedures / adverse effects* Vascular Surgical Procedures / adverse effects* Young Adult |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2009 Aug;111(2):453; author reply 453-4
[PMID:
19625819
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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