The risk of post‐operative myocardial injury after major emergency abdominal surgery: A retrospective cohort study

Ekeloef, Sarah; Bjerrum, Ellen; Kristiansen, Puk; Wahlstrøm, Kirsten Lykke; Burcharth, Jakob; Gögenür, Ismail

doi:10.1111/aas.13622

Cited by 8 publications

(16 citation statements)

References 32 publications

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“…Elevated postoperative cTns are independently prognostic for mortality and MACE. High certainty evidence supports its measurement to aid prognosis of 30-day all-cause mortality 30–42 . Moderate certainty evidence supports the measurement of postoperative cardiac troponins to aid prognosis of 1-year mortality 8,24,33,40,42,45–53 .…”

Section: Clinical Practice Statements Regarding Postoperative Cardiac...mentioning

confidence: 95%

“…High certainty evidence supports its measurement to aid prognosis of 30-day all-cause mortality. [30][31][32][33][34][35][36][37][38][39][40][41][42] Moderate certainty evidence supports the measurement of postoperative cardiac troponins to aid prognosis of 1-year mortality. 8,24,33,40,42,[45][46][47][48][49][50][51][52][53] For the prognosis of MACE very low -low certainty of evidence was found.…”

Section: Rationale For the Use Of Postoperative Cardiac Troponinsmentioning

confidence: 99%

“…Large, observational studies have demonstrated increased cardiac troponin (cTn) levels as prognostic factors in non-cardiac surgery patients. These studies have established an association between increased cTn and cardiovascular and non-cardiovascular complications, poor short- and long-term cardiovascular outcomes and mortality 3–58 . The contribution of cTn to improved/incremental prediction is less well explored 3,10,15,16,18,24,26–32,40–44,55,58 .…”

Section: Introductionmentioning

confidence: 99%

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ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Lurati Buse,

Bollen Pinto,

Abelha

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery. AIMS The aim of this focused guideline was to provide updated guidance regarding the pre-, post- and combined pre-and postoperative use of cardiac troponin and B-type natriuretic peptides in adult patients undergoing noncardiac surgery. METHODS The guidelines were prepared using Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. This included the definition of critical outcomes, a systematic literature search, appraisal of certainty of evidence, evaluation of biomarker measurement in terms of the balance of desirable and undesirable effects including clinical outcomes, resource use, health inequality, stakeholder acceptance, and implementation. The panel differentiated between three different scopes of applications: cardiac biomarkers as prognostic factors, as tools for risk prediction, and for biomarker-enhanced management strategies. RESULTS In a modified Delphi process, the task force defined 12 critical outcomes. The systematic literature search resulted in over 25,000 hits, of which 115 full-text articles formed the body of evidence for recommendations. The evidence appraisal indicated heterogeneity in the certainty of evidence across critical outcomes. Further, there was relevant gradient in the certainty of evidence across the three scopes of application. Recommendations were issued and if this was not possible due to limited evidence, clinical practice statements were produced. CONCLUSION The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.

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Section: Clinical Practice Statements Regarding Postoperative Cardiac...mentioning

confidence: 95%

Section: Rationale For the Use Of Postoperative Cardiac Troponinsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Lurati Buse,

Bollen Pinto,

Abelha

et al. 2023

European Journal of Anaesthesiology

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“…In emergency abdominal surgery, it has been shown that patients with preoperative ischaemic heart disease has an increased risk of postoperative cardiac complications, 5 and a preoperative high cardiac risk index has been linked to increased risk of myocardial injury after surgery. 24 Such potentially preventable cardiac events might contribute to the increased relative risk of pre-operative IVD at long-term. Recently, the MANAGE trial found that more than 15% of patients with perioperative myocardial injury encounter a major vascular event within 2 years after surgery.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Ischaemic vascular disease and long‐term mortality in emergency abdominal surgical patients: A population‐based cohort study

Tvarnø

Lohse

Møller

et al. 2021

Acta Anaesthesiol Scand

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Background Emergency abdominal surgery carries a high mortality, as patients are often frail with significant comorbidity. We aimed to evaluate the association between co‐existing ischaemic vascular disease (IVD) and long‐term mortality in patients undergoing emergency abdominal surgery. Methods We included adult emergency abdominal surgical patients operated on 13 Danish hospitals between 1 January 2009 and 31 December 2010. Appendectomies were excluded. Data were retrieved from the National Patient Registry (NPR) and the Danish Anaesthesia Database. Preoperative IVD status was retrieved from NPR. We used crude and adjusted Cox regression analysis. The primary outcome was mortality within eight years. The secondary outcome was mortality within 30 days. Results We included 4864 patients, of which 2584 (53.7%) died within 8 years. Some 20.9% (1019/4864) had preoperative IVD. The adjusted association between preoperative IVD and mortality within 8 years was hazard ratio (HR) 1.10 (95% confidence interval [CI], 1.00‐1.20; P = .045). At 30 days, this association was HR 0.97 (95% CI, 0.84‐1.13). Conclusion In adult major emergency abdominal surgical patients, preoperative IVD was prevalent and associated with a 10% relative increase in long‐term mortality, but not in short‐term mortality.

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“…MINS may occur following at least 8 per cent of elective procedures 2 , 12 and up to 25 per cent of emergency surgery cases 13 . It is associated with increased mortality within 30 days following surgery 7 as well as longer length of inpatient stay 2 , 14 .…”

Section: Introductionmentioning

confidence: 99%

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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Background Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery. Methods MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups. Results Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies. Conclusion A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes. Registration This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).

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The risk of post‐operative myocardial injury after major emergency abdominal surgery: A retrospective cohort study

Cited by 8 publications

References 32 publications

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Ischaemic vascular disease and long‐term mortality in emergency abdominal surgical patients: A population‐based cohort study

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

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