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Major Cardiac Events After Non-cardiac Surgery

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Abstract

Introduction

Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery.

Methods

The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE.

Results

A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO2) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81–140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12–5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49–3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66–5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01–1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00–1.01).

Conclusions

FiO2, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

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Abbreviations

AMI:

Acute myocardial infarction

APACHE II:

Acute physiology and chronic health evaluation

ASA:

American Society of Anesthesiology

CI:

Confidence interval

GCS:

Glasgow Coma Scale

MCE:

Major cardiac events

NSQIP:

National Surgical Quality Improvement Program

OR:

Odds ratio

PACU:

Post-anesthesia care unit

p25–75:

Percentiles 25–75

RCRI:

Revised cardiac risk index

SAPS II:

Simplified acute physiology score

SICU:

Surgical Intensive Care Unit

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital de São João, Porto, Portugal

    Gabriela Sousa, Ana Lopes, Pedro Reis, Vasco Carvalho, Alice Santos & Fernando José Abelha

  2. Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine, University of Porto, Porto, Portugal

    Fernando José Abelha

Authors
  1. Gabriela Sousa
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  2. Ana Lopes
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  3. Pedro Reis
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  4. Vasco Carvalho
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  5. Alice Santos
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  6. Fernando José Abelha
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Corresponding author

Correspondence to Fernando José Abelha.

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Sousa, G., Lopes, A., Reis, P. et al. Major Cardiac Events After Non-cardiac Surgery. World J Surg 40, 1802–1808 (2016). https://doi.org/10.1007/s00268-016-3476-3

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  • DOI: https://doi.org/10.1007/s00268-016-3476-3

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