Importance Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following non-cardiac surgery. Objective To evaluate national trends in perioperative cardiovascular outcomes and mortality after major non-cardiac surgery and identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions. Design, Setting, Participants Patients who underwent major non-cardiac surgery from 2004 to 2013 were identified using the National Inpatient Sample. Main Outcomes Perioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time. Results Among 10,581,621 hospitalizations for major non-cardiac surgery, perioperative MACCE occurred in 317,479 (3.0%), corresponding to an annual incidence of ≈150,000 after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (p for trend <0.0001; adjusted OR 0.95, 95% CI 0.94–0.97) driven by a decline in frequency of perioperative death (adjusted OR 0.79, 95% CI 0.77–0.81) and AMI (adjusted OR 0.87, 95% CI 0.84–0.89) but with an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (p for trend <0.0001; adjusted OR 1.79; CI 1.73–1.86). Conclusions & Relevance Perioperative MACCE occurs in 1 of every 33 hospitalizations for non-cardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major non-cardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing non-cardiac surgery.

In an observational cohort study from the USA, perioperative AMI occurs in 0.9% of patients undergoing major non-cardiac surgery and is strongly associated with in-hospital mortality. Invasive management of such patients may mitigate some of this excess risk, and further research on the management of perioperative AMI is warranted.

Study design: Retrospective chart review. Objective: To identify the prevalence of overweight and severely overweight (obese) in veterans with spinal cord injury. Setting: Veterans Administration Hospital in Wisconsin. Methods: A retrospective chart review of all the patients registered in the current database with the Spinal Cord Injury Unit in the Veterans Administration Hospital was undertaken Data collected for each patient included age, sex, height, date of assessment of the height, weight, date of assessment of the weight, duration of spinal cord injury and the type of spinal cord injuryparaplegia versus quadriplegia. The body mass index (BMI) was subsequently calculated for each patient and the prevalence of overweight and obesity were determined. Results: There were a total of 408 patients registered in the database with the Spinal Injury Unit. The median age was 56 years, and the mean age 55.8 years. Of all patients with spinal cord injury, 52.2% patients had paraplegia and 47.7% had quadriplegia. The mean duration of injury was 19 years. Of the total number of patients, 46.0% were ASIA A, 11.0% were ASIA B, 12.7% were ASIA C and 29.1% were ASIA D. In all, 27.9% patients had a normal BMI and 3.6% patients were undernourished (BMI less than 18.5 kg/m 2 ). The prevalence of overweight was 65.8% and 29.9% patients were obese. Conclusion: Overweight and obesity are problems of a significant magnitude in veterans with spinal cord injury.Spinal Cord (2006) 44, 92-94.

In patients hospitalized during pregnancy and the puerperium, AMI occurred in 1 of every 12,400 hospitalizations and rates of AMI increased over time. Maternal mortality rates were high. Additional research on the prevention and optimal management of AMI during pregnancy is necessary.

Among patients undergoing major non-cardiac surgery, the burden of cardiovascular risk factors and the prevalence of ASCVD increased over time. Adverse trends in risk profiles require continued attention to improve perioperative cardiovascular outcomes.

No abstract

Although the rates of PCI, invasive management, and revascularization have increased substantially after the exclusion of cardiogenic shock from public reporting in New York, these rates remain consistently lower than those observed in other states without public reporting.

No abstract