Surgical Apgar score is associated with myocardial injury after noncardiac surgery
| Autor: | Jesse M. Ehrenfeld, Paul St. Jacques, L McLean House, Matthew D. McEvoy, Khensani N. Marolen |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Myocardial Infarction Myocardial Ischemia Hemodynamics 030204 cardiovascular system & hematology Risk Assessment law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine Troponin T 030202 anesthesiology law Monitoring Intraoperative Humans Medicine Postoperative Period Myocardial infarction health care economics and organizations Aged Retrospective Studies biology business.industry Troponin I Retrospective cohort study Perioperative Middle Aged medicine.disease Tennessee Intensive care unit Troponin Anesthesiology and Pain Medicine Blood pressure Surgical Procedures Operative Anesthesia biology.protein Female Apgar score Hypotension business |
| Zdroj: | Journal of Clinical Anesthesia. 34:395-402 |
| ISSN: | 0952-8180 |
| Popis: | Study Objective To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. Design Single-center retrospective cohort study of surgical patients from 2007 to 2012. Setting Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center. Patients A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available. Measurements The 10-point Surgical Apgar Score (SAS) was calculated from intraoperative heart rate, blood pressure, and blood loss. Peak troponin (cTn) levels, hospital length of stay, 7- and 30-day postoperative mortality, patient demographics, and prior medical conditions were gathered. Troponin leak was defined as cTn-I 0.6 to 1.5 ng/mL or cTn-T 0.1 to 0.3 ng/mL; perioperative MI criteria were cTn-I greater than 1.5 ng/mL or cTn-T greater than 0.30 ng/mL. Main results Of 46,799 noncardiac surgical cases, 209 (0.4%) and 192 (0.4%) suffered cTn leak and MI, respectively. Low SAS (0-4) was associated with increased risk of cTn leak and perioperative MI (univariate odds ratio, 2.76 and 2.06; 95% confidence interval, 2.20-3.45 and 1.57-2.70, respectively). In multivariable analysis, Surgical Apgar Score, age 65 years or older, American Society of Anesthesiologists physical status greater than or equal to III, emergency surgery, history of MI or hypertension, prolonged intraoperative tachycardia (heart rate >100 beats/min for >59 minutes), and prolonged hypotension (mean arterial pressure 2 minutes) were independently associated with cTn leak and perioperative MI. Conclusions Low SAS scores (0-4) may be associated with cTn elevation after noncardiac surgery. SAS-based risk stratification may guide perioperative cTn surveillance in lieu of routine postoperative screening. |
| Databáze: | OpenAIRE |
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