Gender differences in mortality following non-cardiovascular surgery: an observational study

Grewal, Keerat; Wijeysundera, Duminda N.; Carroll, Jo; Tait, Gordon; Beattie, W. Scott

doi:10.1007/s12630-011-9629-9

Cited by 31 publications

(25 citation statements)

References 23 publications

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“…We have recently shown an error rate of \ 2% in a direct comparison of the patient chart vs the EDW data at the UHN. 13 During the study period, the UHN preoperative assessment clinics evaluated 15,597 consecutive patients, each having a complete CAIS data set. We excluded 4,073 patients who were under the age of 50 or had either urgent or emergent procedures.…”

Section: Methodsmentioning

confidence: 99%

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

Self Cite

101

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The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients L'indice de risque cardiaque modifié dans le nouveau millénaire: une réévaluation prospective et unicentrique de cohorte des variables originales chez 9519 patients consécutifs devant subir une chirurgie non urgente Abstract Purpose Cardiac complications following non-cardiac surgery are major causes of morbidity and mortality. The Revised Cardiac Risk Index (RCRI) has become a standard for predicting post-surgical cardiac complications. This study re-examined the original six risk factors to confirm their validity in a large modern prospective database.Methods Using the definitions in the original risk index, this study included 9,519 patients aged C 50 undergoing elective non-cardiac surgery with an expected length of stay C two days at two major tertiary-care teaching hospitals. The validity of the original predictors was tested in this population using binomial logistic regression modelling, area under the receiver operator curve (ROC) analysis, and the net reclassification index. Results Rates of major cardiac complications with 0, 1, 2, C 3 of the predictors were 0.5%, 2.6%, 7.2%, and 14.4%, respectively, in our patient cohort compared with 0.4%, 1.1%, 4.6%, and 9.7%, respectively, in the original cohort. Similar to the original report, binary logistic regression analysis showed that both preoperative treatment with insulin (odds ratio [OR] 1.4; 95% confidence interval [CI] 0.7 to 2.6) and preoperative creatinine [ 176.8 mmolÁL -1 (OR 1.7; 95% CI 0.8 to 3.6) did not improve the predictive ability of the index. Analysis of the remaining four factors resulted in an area under the curve (AUC) identical to that seen for the reconstructed six-factor RCRI (AUC = 0.79). We found that a Author contributions Christopher Davis organized and performed the analysis, wrote the first draft of the manuscript, and was responsible for major revisions to both the analysis and manuscript. Gordon Tait was responsible for creation of the database and the data integrity. He performed and or supervised quality checks on the data and helped perform the data analysis. Gordon Tait, Jo Carroll, and Duminda N. Wijeysundera made key revisions to the manuscript. Jo Carroll assisted in the creation of the database and quality control of the data. Duminda N. Wijeysundera and W. Scott Beattie were responsible in part for the concept of the study. Duminda N. Wijeysundera revised key aspects of the data analysis. W. Scott Beattie was responsible in part for supervision of the project. He obtained funding for the project, helped write all drafts of the manuscript, and made revisions to the data analysis. Dr. Beattie was Mr. Davis's summer elective supervisor. All authors have seen the data analysis and the revised manuscript and vouch for the authenticity of all aspects of this manuscript. glomerular filtration rate (GFR) \ 30 mLÁmin -1 was a better predictor of major...

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Section: Methodsmentioning

confidence: 99%

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

Self Cite

101

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show abstract

“…[12][13][14][15] The patient characteristics, laboratory values, and postoperative events were retrieved from the hospital electronic charting system, MISYS CPR (QuadraMed Corp, Reston, VA, USA). Surgical information was obtained from ORSOS (McKesson Corp, San Francisco CA, USA), and data regarding drug administration were obtained from the institutional pharmacy database.…”

Section: Study Setting and Patient Samplementioning

confidence: 99%

“…The data were linked using the patient's unique hospital visit number-the accuracy of these data had previously been confirmed. 12 The primary outcome was inhospital death within 30 days of the index surgery.…”

Section: Study Setting and Patient Samplementioning

confidence: 99%

“…We assessed the peak postoperative troponin level, defined as the highest level at any time in the 30 days after surgery. The covariates in the mortality model included 1) preoperative patient characteristics (age, sex) 12 ; 2) a list of the 17 comorbidities constructed from the International Classification of Diseases (ICD) 10 codes 16 ; 3) preoperative laboratory values (creatinine, hemoglobin, international normalized ratio); 4) preoperative cardiovascular drugs (statins, beta blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, acetylsalicylic acid, and anti-coagulants) 13,[17][18][19] ; 5) surgical characteristics (year of surgery, site, surgical service, duration, and emergent status); and 6) transfusion status.…”

Section: Study Setting and Patient Samplementioning

confidence: 99%

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Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Beattie

Karkouti

Tait

et al. 2012

Can J Anesth/J Can Anesth

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“…Studien an großen Patientenkollektiven bei nicht kardiovaskulären Eingriffen zeigten allerdings bereits, dass Männer im Vergleich eine ca. 50 % erhöhte Wahrscheinlichkeit haben, innerhalb der 30-Tage-Letalität zu versterben im Vergleich zu Frauen [11][12][13], dass kritisch kranke Patientinnen mit dem Apache-III-bzw. -IV-Score ein besseres Überleben haben als Männer und dass auch in der Klinik eine Sepsis von Frauen eher überlebt wird als von Männern [14,15] aber es gibt auch divergierende Ergebnisse [16,17] (l " Tab.…”

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Gibt es geschlechterspezifische Unterschiede bei Komplikationen in der offenen Viszeralchirurgie?

Ott

Heger

2015

Zentralbl Chir

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Studies in mice indicate gender-specific differences in surgical complications with a distinct advantage for females. In patient care, however, gender has been an underrated aspect of complication management in abdominal surgery as far. Proven differences between the sexes regarding anatomy, hormonal regulation, constitutional polymorphisms, immune response and psychology suggest different types and incidence of complications and seem to justify studies on the topic. This review aims to compare a selection of current original articles reporting on complications following abdominal surgery separately for the genders. However, data in the literature are sparse and in part very heterogeneous. With data on colorectal carcinoma being most comprehensive, for stomach, oesophagus and finally pancreas fewer data can be found. Summing up all organ systems, the following cautious conclusions can be drawn. Men tend to suffer from postoperative complications more frequently. Men have more cases of anastomotic leakage, whereas women suffer from anastomotic stenosis more often. Currently, however, existing data do not justify any adaptation of patient management. Thus, taking gender aspects into account in designing new trials is paramount in order to obtain robust gender-specific data on incidence and types of complications.

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Gender differences in mortality following non-cardiovascular surgery: an observational study

Cited by 31 publications

References 23 publications

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Gibt es geschlechterspezifische Unterschiede bei Komplikationen in der offenen Viszeralchirurgie?

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