Skip to main content

Advertisement

SpringerLink
Log in

Surgery in Cancer Patients: Risk Factors for Major Adverse Cardiac Events

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The major adverse cardiac events (MACE) are a major cause of perioperative death in patients of cancer combined with coronary heart disease. The risk factors of postoperative MACE in this specific population should be fully understood and analyzed to provide a theoretical basis for optimal management strategy. A total of 484 patients of cancer combined with coronary heart disease admitted to the intensive care unit of our hospital from January 2014 to December 2018 were retrospectively analyzed. The endpoint of observation was postoperative MACE. According to this endpoint, the patients were divided into the MACE group and the non-MACE group. The clinical baseline characteristics, additional examinations, and surgery-related indicators of the two groups were compared. Risk factors of MACE were analyzed by univariate and multivariate logistic analysis. A total of 56 patients (11.6%) were diagnosed with MACE during postoperative hospitalization in 484 patients. Univariate and multivariate logistic analyses were performed on the two groups: age (P = 0.021), history of heart failure (P = 0.033), history of angina within 6 months (P = 0.001), cardiac ejection fraction (P = 0.011), intraoperative hypoxia (P = 0.021), and intraoperative hypotension (P = 0.001) were Independent risk factors of MACE. The incidence of MACE was high in patients of cancer combined with coronary heart disease after non-cardiac surgery. Its independent risk factors include age, history of heart failure, history of angina within 6 months, cardiac ejection fraction, intraoperative hypoxia, and intraoperative hypotension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Laohathai S, Ngodngamthaweesuk M, Chantrathammachart P, Leelayana P, Cherntanomwong P, Khajarern S (2017) Mortality and thromboembolic events in hypercoagulable states from ROTEM-thromboelastometry in patients who undergo coronary bypass surgery. Heart Lung Circ 26:S402

    Article  Google Scholar 

  2. Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, Khreiss M, Dahdaleh FS, Khavandi K, Sfeir PM (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378(9800):1396–1407

    Article  Google Scholar 

  3. Franek E, Osinska B, Czech M, Figat J (2013) Mortality after surgery in Europe. Lancet 381(9864):369–370

    Article  Google Scholar 

  4. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR (2009) 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 54(22):e13–e118

    Article  Google Scholar 

  5. Bosiers MJ, Tran K, Lee JT, Donas KP, Veith FJ, Torsello G, Pecoraro F, Stavroulakis K, Dalman RL, Lachat M (2018) Incidence and prognostic factors related to major adverse cerebrovascular events in patients with complex aortic diseases treated by the chimney technique. J Vasc Surg 67(5):1372–1379

    Article  Google Scholar 

  6. Wu W-C, Schifftner TL, Henderson WG, Eaton CB, Poses RM, Uttley G, Sharma SC, Vezeridis M, Khuri SF, Friedmann PD (2007) Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. Jama 297(22):2481–2488

    Article  CAS  Google Scholar 

  7. Sousa G, Lopes A, Reis P, Carvalho V, Santos A, Abelha FJ (2016) Major cardiac events after non-cardiac surgery. World J Surg 40(8):1802–1808

    Article  Google Scholar 

  8. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049

    Article  CAS  Google Scholar 

  9. Kheterpal S, O’Reilly M, Englesbe MJ, Rosenberg AL, Shanks AM, Zhang L, Rothman ED, Campbell DA, Tremper KK (2009) Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology 110(1):58–66

    Article  Google Scholar 

  10. Carroll K, Majeed A, Firth C, Gray J (2003) Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register. J Public Health 25(1):29–35

    Article  Google Scholar 

  11. Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, Lee TH (2001) Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 134(8):637–643

    Article  CAS  Google Scholar 

  12. Flynn B, Vernick W, Ellis J (2011) β-Blockade in the perioperative management of the patient with cardiac disease undergoing non-cardiac surgery. Br J Anaesth 107(suppl_1):i3–i15

    Article  CAS  Google Scholar 

  13. Saito S, Takagi A, Kurokawa F, Ashihara K, Hagiwara N (2012) Usefulness of tissue Doppler echocardiography to predict perioperative cardiac events in patients undergoing noncardiac surgery. Heart Vessel 27(6):594–602

    Article  Google Scholar 

  14. Kertai M, Boersma E, Bax J, Heijenbrok-Kal M, Hunink M, L’talien G, Roelandt J, Van Urk H, Poldermans D (2003) A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart 89(11):1327–1334

    Article  CAS  Google Scholar 

  15. Shah KB, Kleinman BS, Rao T, Jacobs HK, Mestan K, Schaafsma M (1990) Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations. Anesth Analg 70(3):240–247

    Article  CAS  Google Scholar 

  16. Singh A, Antognini JF (2011) Perioperative hypotension and myocardial ischemia: diagnostic and therapeutic approaches. Ann Card Anaesth 14(2):127–132

    Article  Google Scholar 

  17. Gal J, Bogar L, Acsady G, Kertai M (2006) Cardiac risk reduction in non-cardiac surgery: the role of anaesthesia and monitoring techniques. Eur J Anaesthesiol 23(8):641–648

    Article  CAS  Google Scholar 

  18. Sabate S, Mases A, Guilera N, Canet J, Castillo J, Orrego C, Sabaté A, Fita G, Parramón F, Paniagua P (2011) Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery. Br J Anaesth 107(6):879–890

    Article  CAS  Google Scholar 

  19. Group PS (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847

    Article  Google Scholar 

  20. Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ (2007) An Apgar score for surgery. J Am Coll Surg 204(2):201–208

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Critical Care Medicine, Peking University Cancer Hospital & Institute, Beijing, 100142, China

    Yong Yang & Hong-Zhi Wang

Authors
  1. Yong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong-Zhi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-Zhi Wang.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Y., Wang, HZ. Surgery in Cancer Patients: Risk Factors for Major Adverse Cardiac Events. Indian J Surg 82, 1011–1015 (2020). https://doi.org/10.1007/s12262-020-02238-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-020-02238-3

Keywords

Search

Navigation