Associations between different measures of intra-operative tachycardia during noncardiac surgery and adverse postoperative outcomes

Abstract

BACKGROUND Intra-operative tachycardia during noncardiac surgery has been associated with adverse postoperative outcomes. However, harm thresholds for tachycardia have not been uniformly defined. The definition of intraoperative tachycardia that best correlates with adverse postoperative outcomes remains unclear.OBJECTIVE We aimed to identify the definition of intraoperative tachycardia during noncardiac surgery that is associated with the best predictive ability for adverse postoperative outcomes.DESIGN A single-centre retrospective cohort analysis.SETTING Secondary care hospital, Afula, Israel.PATIENTS AND METHODS Adults who underwent elective or nonelective noncardiac surgery during 2015 to 2019. Five intra-operative heart rate (HR) cut-off values and durations were applied with penalised logistic regression modelling for the outcome measures. MAIN OUTCOME MEASURESThe primary outcome was all-cause 30-day mortality; the secondary outcome was myocardial ischaemia or infarction (MI) within 30 days after noncardiac surgery. RESULTSThe derivation and validation datasets included 6490 and 4553 patients, respectively. Altogether, all-cause 30-day mortality and MI rates averaged 2.1% and 3.2%, respectively. Only two definitions of intra-operative tachycardia were significantly associated with the outcome measures: HR ! 100 bpm for ! 30 min and HR ! 120 bpm for ! 5 min. The C-statistics of the base models without tachycardia exposure for all-cause 30-day mortality and MI were 0.75 (95% confidence interval, CI, 0.74 to 0.78) and 0.73 (95% CI, 0.72 to 0.76), respectively. The addition of intra-operative tachycardia exposure to the base models significantly improved their predictive performance. The highest area under the curve (AUC) was achieved when tachycardia was defined as an intra-operative HR ! 100 bpm for at least 30 min: AUC 0.81 (95% CI, 0.80 to 0.84) and AUC 0.80 (95% CI, 0.79 to 0.82) for all-cause 30-day mortality and MI, respectively.CONCLUSION Intra-operative tachycardia, defined as an intra-operative HR ! 100 bpm for at least 30 min, was associated with the highest predictive power for adverse postoperative outcomes.

Incidence and risk factors for myocardial injury after laparoscopic adrenalectomy for pheochromocytoma: A retrospective cohort study

“…However, we noticed that the injury was apparent when the intraoperative HR exceeded 115 bpm (aOR, 2.55 [95% CI: 1.06–6.12]). Furthermore, the threshold for tachycardia gradually decreased as the cumulative duration increased in our study, consistent with the results of previous observational studies ( 24 , 36 ).…”

“…Troponin elevation has also been strongly associated with higher morbidity and 30-day mortality ( 17 – 20 ). Previous studies ( 21 – 24 ) have reported the perioperative risk factors of myocardial injury after non-cardiac surgeries. In addition to intraoperative heart rate (HR) and blood pressure (BP), patient characteristics are also associated ( 16 , 22 ).…”

Perioperative Acute Myocardial Infarction and Ischemia After Noncardiac Surgery: Pathophysiology, Prevention, and Nursing Implications

“…47 In a cohort of adult patients undergoing surgery under general anesthesia, patients whose heart rates were greater than or equal to 100 beats per minute for 30 minutes or longer had a 2.1-fold increase in mortality within 30 days of surgery compared with those who did not experience this tachycardia; a heart rate of greater than or equal to 120 beats per minute for five minutes or longer produced a 50% increase in mortality. 47 Intraoperative hypotension and tachycardia appear to have an additive effect on the risk of AMI. 48 These and similar findings have led to a PeriOperative Quality Initiative consensus statement recommendation on perioperative BP management.…”

Comparison of safety of general anesthesia and intravenous sedation during third-molar extraction surgery: a retrospective study of 1,260 cases

“…Bradycardia was de ned as a 5-minute average HR decreasing to < 60 bpm or the administration of anticholinergic medications, such as atropine or glycopyrrolate [26]. Tachycardia was de ned as an average HR > 120 bpm or the use of esmolol to decrease HR [27]. Hypoxemia was de ned as SpO 2 < 95%, and severe hypoxemia as SpO 2 < 90% [28].…”