Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

Abstract

Introduction: Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index. Methods: The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index. Results: In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A4CH model utilized six variables: Age ⩾75 years, ASA class >2, Anemia, surgical Approach, Creatinine >1.5, and history of Heart disease. Index ROC analysis provided a C-statistic of 0.81, calibration R2 was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively. Conclusion: This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

“…Similarly, increased MI, bleeds, and UTIs in patients with diabetes may endorse a need for improved cardiac monitoring, antibiotic prophylaxis, and wound closure strategies. Procedure-specific risk calculation indices have been previously proposed, including an algorithm predicting risk of major adverse cardiovascular events following PN based on demographics and baseline factors [27]. Interestingly, this algorithm does not include diabetes, although our study identified diabetes as a significant predictor of MI.…”

Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate

“…Postoperative complications were compared between the different anesthesia techniques that included return to operative room, urinary tract infection, occurrence of pneumonia, sepsis, bleeding transfusion, pulmonary embolism and deep vein thrombosis (PE/DVT), renal failure, septic shock, reintubation defined as any incidence of unplanned intubation intraoperatively or postoperatively that was not intended or planned that could include, but is not limited to, unplanned intubations for refractory hypotension, cardiac arrest, or inability to protect airway, failure to wean defined as ventilator-assisted respirations for more than 48 h after surgery, and major adverse cardiovascular event (MACE) defined as the occurrence of stroke, cardiac arrest, or death. 16 Re-intubation does not include the following cases: patients returned to the operative room for an unplanned reintervention, patients undergoing time off the ventilator during weaning trials and fail the trial and placed back on ventilator, intraoperative conversion from local or monitored anesthesia care (MAC) to general anesthesia, in the absence of an emergency, secondary to a patient not tolerating local or MAC anesthesia, and patient self-extubation requiring reintubation. 17 Furthermore, surgical characteristics were compared between the different anesthesia techniques that included operative time, time from anesthesia start to surgery start, and time from surgery stop to anesthesia stop.…”

The Role of the Cardiac Biomarkers in the Renal Cell Carcinoma Multidisciplinary Management

“…Nasrallah et al proposed the PN-A4CH model (Age ≥ 75 years, American Society of Anesthesiologist class > 2, Anaemia, surgical Approach, Creatinine > 1.5 and history of Heart disease) as a risk index to predict MACE [44].…”