A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Skinner, David Lee; Goga, Saaliha; Rodseth, Reitze; Biccard, Bruce

doi:10.1080/22201173.2012.10872851

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…Using published data from all studies, we determined adjusted odds ratios (OR) for all outcomes. All reported hazard ratios and risk ratios were converted to ORs for the meta-analysis [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…We tested this hypothesis in a recent meta-analysis [ 8 ] where we aimed to determine which preoperative cardiac risk factors remained predictive of adverse cardiac events when taking into account independent intraoperative risk factors. To be eligible for inclusion in the meta-analysis, studies had to have examined both pre- and intraoperative risk factors associated with adverse cardiac events, using multivariable regression.…”

Section: Introductionmentioning

confidence: 99%

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What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review

Biccard

Rodseth

2013

Perioper Med

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BackgroundPatients undergo cardiac preoperative evaluation to identify those at risk of adverse perioperative cardiac events. The Revised Cardiac Risk index is commonly used for this task, although it is unable to accurately risk stratify in all patients. This may be partly a result of intraoperative events which significantly modify preoperative risk.MethodsWe conducted a systematic review to identify independent intraoperative predictors of adverse cardiac events in patients undergoing non-cardiac surgery. Four databases (Ovid Healthstar 1966 to Jan 2012, Ovid Medline 1946 to 6 March 2012, EMBASE 1974 to March 05 2012 and The Cochrane Library to March 06 2012) were searched.ResultsFourteen eligible studies were identified. The need for intraoperative blood transfusion (odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.3), vascular surgery (OR, 2.3; 95% CI, 1.2-3.4) and emergent/urgent surgery (OR, 2.3; 95% CI, 1.1-3.5) were the only independent intraoperative risk predictors identified in more than study. Other independent intraoperative factors identified included a >20 mmHg fall in mean arterial blood pressure for > 60 min (OR, 3.0; 95% CI, 1.8-4.9), >30% increase in baseline systolic pressure (OR, 8.0; 95% CI, 1.3-50), tachycardia in the recovery room (>30 beats per min (bpm) from baseline for >5 min) (OR, 7; 95% CI, 1.9-26), new onset atrial fibrillation (OR, 6.6; 95% CI, 2.5-20), hypothermia (OR, 2.2; 95% CI, 1.1-5) and remote ischemic preconditioning (OR, 0.22; 95% CI, 0.07-0.67). Other markers of surgical complexity were not independently associated with postoperative adverse cardiac outcomes. None of these studies controlled for blood transfusion.ConclusionsIntraoperative events significantly increase the risk for postoperative cardiac complications, although only intraoperative blood transfusion has strong evidence supporting this finding. It is possible that modification of these intraoperative risk factors by anesthetists and surgeons may reduce postoperative cardiac events and improve outcome. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study will add important information to understanding intraoperative risk factors for adverse cardiac events.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review

Biccard

Rodseth

2013

Perioper Med

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“…In addition, the adjusted odds ratios (OR) and 95% confidence interval (CI) associated with an elevated preoperative NP measurement for the outcome of AF were extracted, and all reported hazard ratios and relative risk statistics were converted to odds ratios for meta-analysis. 6 Meta-analysis was conducted using a random effects model in Review Manager Version 5.1. (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011).…”

Section: Eligibility Assessmentmentioning

confidence: 99%

The Use of Preoperative B-Type Natriuretic Peptide as a Predictor of Atrial Fibrillation After Thoracic Surgery: Systematic Review and Meta-Analysis

Simmers

Potgieter

Ryan

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…functional status [23], major surgery [8,22], duration of surgery [24] and blood transfusion [25]. We decided to determine whether pre-operative hypertension was independently associated with peri-operative haemodynamic instability known to be associated with adverse peri-operative outcomes.…”

Section: C) Introductionmentioning

confidence: 99%

The relationship between pre‐operative hypertension and intra‐operative haemodynamic changes known to be associated with postoperative morbidity

et al. 2018

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Hypertension is not consistently associated with postoperative cardiovascular morbidity and is therefore not considered a major peri-operative risk factor. However, hypertension may predispose to peri-operative haemodynamic changes known to be associated with peri-operative morbidity and mortality, such as intra-operative hypotension and tachycardia. The objective of this study was to determine whether pre-operative hypertension was independently associated with haemodynamic changes known to be associated with adverse peri-operative outcomes. We performed a five-day multicentre, prospective, observational cohort study which included all adult inpatients undergoing elective, non-cardiac, non-obstetric surgery. We recruited 343 patients of whom 164 (47.8%) were hypertensive. An intra-operative mean arterial pressure of < 55 mmHg occurred in 59 (18.2%) patients, of which 25 (42.4%) were hypertensive. Intra-operative tachycardia (heart rate> 100 beats.min ) occurred in 126 (38.9%) patients, of whom 61 (48.4%) were hypertensive. Multivariable logistic regression did not show an independent association between the stage of hypertension and either clinically significant hypotension or tachycardia, when controlled for ASA physical status, functional status, major surgery, duration of surgery or blood transfusion. There was no association between pre-operative hypertension and peri-operative haemodynamic changes known to be associated with major morbidity and mortality. These data, therefore, support the recommendation of the Joint Guidelines of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society to proceed with elective surgery if a patient's blood pressure is < 180/110 mmHg.

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A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Cited by 7 publications

References 21 publications

What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review

What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review

The Use of Preoperative B-Type Natriuretic Peptide as a Predictor of Atrial Fibrillation After Thoracic Surgery: Systematic Review and Meta-Analysis

The relationship between pre‐operative hypertension and intra‐operative haemodynamic changes known to be associated with postoperative morbidity

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