Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Devereaux, P. J.; Sessler, Daniel I.

doi:10.1056/nejmra1502824

Cited by 405 publications

(330 citation statements)

References 94 publications

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“…Prior coronary stenting is a well-established risk factor associated with major adverse cardiac events. 1,[16][17][18][19] More recently, however, Holcomb and colleagues demonstrated that the incremental risk of cardiac complications significantly decreases when surgery is performed more than 6 months following coronary stenting: the incremental risk of cardiac complications stabilizes at 1% beyond 6 months following coronary stenting. 20 Although NSQIP excludes those with prior percutaneous coronary intervention within 6 months of hepatectomy, we still found that those with history prior PCI (>6 months before the liver resection) had a cardiac complication rate of 6.4% as well as a three-fold increase risk of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

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The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

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Section: Discussionmentioning

confidence: 99%

“…1 Preoperative cardiac disease is a well-known risk factor associated with poor surgical outcomes following vascular 2,3 and colorectal surgery. [4][5][6] The risk of mortality increases 5-fold in patients with prior ischemic heart disease undergoing non-cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

HPB

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“…Data on the clinical characteristics of patients who undergo non cardiac surgery are available in the international literature. Guidelines recommend standardized management protocols for elderly surgery patients and diverse strategies have been proposed for assessing the preoperative risk in the more advanced ages [5][6][7][8]. Also in Italy, several studies have documented the impact of elderly age in non cardiac surgery and, in particular, the problem of comorbidity [2,9].…”

Section: Importance Of the Issue And Epidemiological Datamentioning

confidence: 99%

Age-related prevalence of non-cardiac surgery indications

Agabiti

2017

Monaldi Arch Chest Dis

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A clear trend in Italy over the last 20 years has been the increasing prevalence of "very old" people (over 75 years of age) within the general population. Routine statistics as well as population surveys and ad hoc epidemiological studies all confirm this trend. The proportion of socalled "very old patients in good health" is the category which is increasing the most. This is due to the economic well-being and generally good living conditions in Italy as well as progress in medical care and the introduction of new treatments and technologies in clinical practice that have improved survival and quality of life. The presence of an increasing number of very old people in the population, with consequent change of the population's health needs, represents a great challenge both for the healthcare system and for society as a whole. Importance of the issue and epidemiological dataBased on ISTAT (Italian National Bureau of Statistics), Italy has 6,828,610 individuals who are aged over 75 years, corresponding to 11% of the total population, and more than 4.7 million elderlies aged between 75 and 84 years, representing as much as 7.8% of the total population. The group of the "oldest old" (aged ≥ 85 years) comprises more than 1.9 million individuals, corresponding to 3.2% of the total population living in Italy. The category of the "oldest old" is the one showing the greatest increase over the years, passing from 3.5% (of the >65 years of age) in 2010 to 5.2% in 2016 [1][2][3]. Among the conditions of surgical risk in the elderly, one of the most frequent is hip fracture. In Italy, in 2014, there were reported 117,436 hospital admissions for hip fracture, 80% of which were among people aged >75 years [4]. Data on the clinical characteristics of patients who undergo non cardiac surgery are available in the international literature. Guidelines recommend standardized management protocols for elderly surgery patients and diverse strategies have been proposed for assessing the preoperative risk in the more advanced ages [5][6][7][8]. Also in Italy, several studies have documented the impact of elderly age in non cardiac surgery and, in particular, the problem of comorbidity [2,9]. A recent epidemiological study reported the clinical characteristics of patients admitted for hip fracture between 2007 and 2010 to hospitals in the Lazio region, based on data from the Hospital Information System (Sistema Informativo Ospedaliero, SIO). The prevalence of diabetes was 6.1%, heart disease 21.2%, cerebrovascular disease 14.7%, hypertension 30.7%, diseases of the central nervous system 11.6%, chronic kidney disease (CKD) 6.3%, and chronic obstructive pulmonary disease (COPD) 6.3%. These comorbidities played a significant role both in reducing the probability of early surgery (considered fundamental for a good prognosis, but overall only 20.3% were operated within 48 hours) -as well as an adverse prognostic factor for mortality at 30 days (overall 30-day mortality 7.5%) [10]. In a larger sample of patients with hip fracture ident...

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“…Unstable atherosclerotic plaque rupture leading to thrombus formation and stress induced ischemia due to mismatch between the myocardial oxygen supply and demand during intubation or intraoperative tachycardia (due to hypotension or bleeding) are the main mechanisms of perioperative cardiac complications (1,3).…”

Section: Introductionmentioning

confidence: 99%

Benefits and Harms of Beta Blockers in the Perioperative Period of Non-Cardiac Surgery: A Narrative Review

Sherafati

Mollazadeh

2017

Arch Neurosci

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Several trials have evaluated the role of treatment with beta-blockers in patients undergoing non-cardiac surgery. Debates are when and which agent and dosage to initiate and when and how to continue or discontinue. In addition, effects on perioperative arrhythmia, myocardial infarction, stroke, and mortality were studied. Herein we have tried to review the most common guidelines and large trials on the aforementioned issues.

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Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Cited by 405 publications

References 94 publications

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Age-related prevalence of non-cardiac surgery indications

Benefits and Harms of Beta Blockers in the Perioperative Period of Non-Cardiac Surgery: A Narrative Review

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