Incidence of and Risk Factors for Cardiovascular Complications After Thoracic Surgery for Noncancerous Lesions

Pipanmekaporn, Tanyong; Punjasawadwong, Yodying; Charuluxananan, Somrat; Lapisatepun, Worakitti; Bunburaphong, Pavena; Patumanond, Jayanton; Saeteng, Somchareon; Chandee, Theerada

doi:10.1053/j.jvca.2014.02.002

Cited by 13 publications

(15 citation statements)

References 35 publications

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“…Such patients are prone to develop intraoperative hypotension and have an increased risk of myocardial ischemia 22. Our previous study demonstrated that diabetes mellitus and coronary artery disease were significant independent risk factors for cardiovascular complications after thoracic surgery 12. In addition, patients with diabetes mellitus and coronary artery disease are at increased risk of myocardial ischemia, congestive heart failure, or death after noncardiac surgery 21,23,24.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative positive fluid balance (PFB) significantly increases the risk of postoperative pulmonary complications after thoracic surgery;10,11 however, the influence of this factor on postoperative cardiovascular complications has not been clearly demonstrated 10,11. Our previous study showed that perioperative PFB >2,000 mL was one of the significant risk factors for cardiovascular complications after thoracic surgery 12. The purpose of this study was to explore the influence of PFB on cardiovascular complications after thoracotomy for noncancer lesions.…”

Section: Introductionmentioning

confidence: 98%

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Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Pipanmekaporn¹,

Punjasawadwong²,

Charuluxananan³

et al. 2014

RMHP

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ObjectiveThe purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions.MethodsAfter approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients undergoing thoracotomy between January 1, 2005 and December 31, 2011 in a single medical center were recruited. The primary outcome of the study was the incidence of cardiovascular complications, which were defined as cardiac arrhythmia, cardiac arrest, heart failure, myocardial ischemia, and pulmonary embolism. Univariable and multivariable risk regression analyses were used to evaluate the association between positive fluid balance and cardiovascular complications.ResultsA total of 720 patients were included in this study. The incidence of cardiovascular complications after thoracotomy for noncancer lesions was 6.7% (48 of 720). Patients with positive fluid balance >2,000 mL had a significantly higher incidence of cardiovascular complications than those with positive fluid balance ≤2,000 mL (22.2% versus 7.0%, P=0.005). Cardiac arrhythmias were the most common complication. Univariable risk regression showed that positive fluid balance >2,000 mL was a significant risk factor (risk ratio =3.15, 95% confident interval [CI] =1.44–6.90, P-value =0.004). After adjustment for all potential confounding variables during multivariable risk regression analysis, positive fluid balance >2,000 mL remained a strong risk factor for cardiovascular complications (risk ratio =2.18, 95% CI =1.36–3.51, P-value =0.001). Causes of positive fluid balance >2,000 mL included excessive hemorrhage (48%), hypotension without excessive hemorrhage (29.6%), and liberal fluid administration (22.4%).ConclusionPositive fluid balance was a significant risk factor for cardiovascular complications. Strategies to minimize positive fluid balance during surgery for patients at high risk of cardiovascular complications include preparing adequate blood and blood products, considering appropriate hemoglobin level as a transfusion trigger, and adjusting the optimal dose of local anesthetic for intraoperative thoracic epidural analgesia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Pipanmekaporn¹,

Punjasawadwong²,

Charuluxananan³

et al. 2014

RMHP

Self Cite

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“…20,29 Nine studies investigated myocardial injury or infarction, with a follow-up duration between 1 and 30 days. 11,14,17 The incidence of myocardial injury varied between 0.09% (in-hospital) and 30% (1 day). 11,39 Stroke was reported in four studies, with incidences varying from 0.004% (in-hospital) to 0.09% (10 days).…”

Section: Studied Outcomesmentioning

confidence: 99%

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Wesselink

Kappen

Torn

et al. 2018

British Journal of Anaesthesia

550

454

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The reported associations suggest that organ injury might occur when mean arterial pressure decreases <80 mm Hg for ≥10 min, and that this risk increases with blood pressures becoming progressively lower. Given the retrospective observational design of the studies reviewed, reflected by large variability in patient characteristics, hypotension definitions and outcomes, solid conclusions on which blood pressures under which circumstances are truly too low cannot be drawn. We provide recommendations for the design of future studies. CLINICAL REGISTRATION NUMBER: (PROSPERO ID). CRD42013005171.

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“…Postoperative acute kidney injury (AKI) is a serious complication of surgical procedures that is associated not only with short-term increases in mortality [ 1 – 3 ] but also with long-term complications such as development of chronic kidney disease [ 4 ]. Predictors of postoperative AKI have been extensively studied in cardiac surgery [ 5 – 22 ], and to a lesser extent in non-cardiac surgery [ 23 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…As reported in previous studies, these predictors include age, female sex, types of surgery (valvular surgery versus coronary artery bypass grafting in cardiac surgery and intra-thoracic or intra-abdominal surgery versus others in non-cardiac surgery), emergency surgery, preoperative renal dysfunction, body mass index (BMI), smoking, diabetes mellitus (DM), the use of insulin, hypertension, chronic obstructive pulmonary disease (COPD), atrial fibrillation, peripheral arterial disease (PAD), cerebrovascular disease (CVA), coronary artery disease (CAD), preoperative hematocrit, coagulopathy, thrombocytopenia, the use of vasopressors, left ventricular dysfunction, pre- and/or intra-operative use of iodinated contrast, diuretics, angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) [ 5 – 30 ]. Among these predictors of AKI, pre- and/or intra-operative use of diuretics, ACE-I or ARB is possibly modifiable.…”

Section: Introductionmentioning

confidence: 99%

Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study

2015

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Background and ObjectivesPre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery.Design, Setting, Participants, and MeasurementsThis was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output < 0.5 ml/kg/hour for > 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed.ResultsThere were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1).ConclusionsPrescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use. It might be reasonable to withhold preoperative diuretics in these patients.

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Incidence of and Risk Factors for Cardiovascular Complications After Thoracic Surgery for Noncancerous Lesions

Cited by 13 publications

References 35 publications

Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study

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