Surgical risk in the cardiac patient

Skinner, John F.; Pearce, Morton Lee

doi:10.1016/0021-9681(64)90039-6

Cited by 85 publications

(23 citation statements)

References 8 publications

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“…Operative site also affected the incidence of post-operative respiratory complications in our patients, with upper and lower GI procedures having similar inci dences of respiratory morbidity while her niorrhaphies and non-abdominal procedures had much lower incidences. A similar pattern was also reported in elderly patients by Mlynek et al [ 1977], In younger patients, abdom inal operations are also associated with a higher incidence of post-operative respira tory complications than non-abdominal operations, but the highest incidence of all is seen with those incisions which are closest to the diaphragm [ Wight man, 1968;Pierce and Robertson, 1977;Harman and Lillinglon, 1979], Poor pre-operative fitness, as measured by various techniques [Skinner and Pearce, 1964;Vacanti et al, 1970;Goldman et al, 1977;Rose et al, 1979;Garibaldi et al, 1981] appears to have a detrimental effect on post-operative morbidity in the elderly. In the present report, we have introduced a new measurement of fitness, based simply on the pre-operative level o f activity.…”

Section: Risk Factors For Post-operative Morbidity In the Agedmentioning

confidence: 49%

Post-Operative Complications in the Elderly Surgical Patient

1983

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A prospective study of post-operative morbidity in 258 elderly general surgical patients is reported. In 35% of patients no post-operative complications developed. Respiratory, wound and cardiac complications were the leading types of post-operative morbidity encountered, occurring in 39.5, 16.3, and 12.4% of patients, respectively. Life-threatening complications developed after surgery in 18.6% of patients, and the post-operative mortality rate (excluding ‘non-viable’ patients) was 5.8%. A statistical analysis of the effect of sex, age, urgency of surgery, type of surgery, and patient fitness on the pattern of post-operative morbidity revealed a number of significant associations which have not been previously identified in the elderly surgical patient.

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Section: Risk Factors For Post-operative Morbidity In the Agedmentioning

confidence: 49%

Post-Operative Complications in the Elderly Surgical Patient

1983

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“…There have been only a few observational studies that have examined the impact of severe AS on the postoperative outcomes in patients undergoing NCS. [3][4][5][6][7] Most of these were small observational studies with conflicting results. Moreover, recent advances in anesthesia for highrisk patients, intraoperative monitoring, and postoperative management techniques limit the relevance of these studies to contemporary practice.…”

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confidence: 99%

Impact of Aortic Stenosis on Postoperative Outcomes After Noncardiac Surgeries

Agarwal

Rajamanickam

Bajaj

et al. 2013

Circ: Cardiovascular Quality and Outcomes

118

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Background— Preoperative management of patients with aortic stenosis (AS) who need noncardiac surgery (NCS) remains controversial. We sought to determine the impact of AS on the postoperative outcomes after NCS. Methods and Results— Patients undergoing NCS with moderate AS (valve area: 1.0–1.5 cm 2 ) or severe AS (valve area: <1.0 cm 2 ) were identified using the surgical and the echocardiographic databases. Using propensity score analysis, we obtained 4 matched control patients without AS for each patient with AS undergoing NCS. The propensity score matching used the 6 revised cardiac risk index criteria, in addition to age and sex. Primary outcome was a composite of 30-day mortality and postoperative myocardial infarction. We matched 634 patients with AS undergoing NCS to 2536 controls. There were 244 patients with severe AS and 390 patients with moderate AS. Thirty-day mortality was 2.1% for AS patients compared with 1.0% in non-AS controls ( P =0.036). Postoperative myocardial infarction was more frequent in patients with AS compared with controls (3.0% versus 1.1%; P =0.001). Combined primary outcome was significantly worse for both moderate and severe AS patients compared with respective controls (4.4% versus 1.7%; P =0.002; and 5.7% versus 2.7%; P =0.02, respectively). High-risk surgery, symptomatic severe AS, coexisting mitral regurgitation, and preexisting coronary disease were significant predictors of primary outcome in patients with AS. Conclusion— Presence of AS adversely affects postoperative outcomes among patients undergoing NCS, evidenced by a higher 30-day mortality and postoperative myocardial infarction after NCS.

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“…In the early 1960s, a retrospective study of cardiac risk among 766 patients found 10% mortality among 59 patients with an aortic valve abnormality. 16 The 15 patients who underwent either intrathoracic or intra-abdominal procedures did particularly poorly, with a mortality of 20%. As part of a large cohort study used to develop the first widely employed cardiac risk index for noncardiac surgery, Goldman et al found 13% (3/23 patients) cardiac mortality among patients with ''important valvular AS.''…”

Section: Noncardiac Surgery and Asmentioning

confidence: 97%

Core competency review: Aortic stenosis and noncardiac surgery

Wright

Hunt

2012

Journal of Hospital Medicine

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Aortic stenosis (AS) poses a risk of adverse cardiac events for patients undergoing surgical procedures. Perioperative mortality for patients with severe AS is as high as 14%. This review examines the accuracy of the history and physical examination in detecting AS and, subsequently, in assessing severity. The utility of echocardiography is addressed, and the relevant pathophysiology of AS is summarized. We also summarize what is known about perioperative risk for patients with AS. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Surgical risk in the cardiac patient

Cited by 85 publications

References 8 publications

Post-Operative Complications in the Elderly Surgical Patient

Post-Operative Complications in the Elderly Surgical Patient

Impact of Aortic Stenosis on Postoperative Outcomes After Noncardiac Surgeries

Core competency review: Aortic stenosis and noncardiac surgery

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