Korean J Anesthesiol.
2024 Feb;77(1):66-76. 10.4097/kja.23043.
Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study
- Choi B
1 - Oh AR2,3
- Park J1,2
- Lee JH2
- Yang K1,4
- Lee DY1
- Rhee SY5
- Kang SS6
- Lee SD7
- Lee SH8
- Jeong CW9
- Park B1,10
- Seol S1
- Park RW1
- Lee S11
- Affiliations
-
- 1Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
- 2Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 3Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
- 4Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 5Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- 6Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
- 7Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- 8Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- 9Central Research Center of Biomedical Research Institute, Wonkwang University Hospital, Iksan, Korea
- 10Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
- 11Department of Cardiology, Wiltse Memorial Hospital, Suwon, Korea
- KMID: 2551483
- DOI: http://doi.org/10.4097/kja.23043
Abstract
- Background
Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records.
Methods
Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis.
Results
After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk).
Conclusions
A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Perioperative management of cardiovascular medication
- The Effect of Hypertension History on the Application of a Computer Program for the Prediction of Perioperative Myocardiac Infarction and Cardiac Mortality to Non-cardiac Surgical Patients
- Preoperative Assessment of Cardiac Risk in the Patient with Diabetes
- Utility of B-Type Natriuretic Peptide for Predicting Perioperative Cardiovascular Events in Patients Without History of Cardiovascular Disease Undergoing Major Non-Cardiac Surgery
- Preoperative cardiac evaluation with transthoracic echocardiography before non-cardiac surgery
