Intra-operative tachycardia and peri-operative outcome

Hartmann, Bernd; Jünger, Alexander; Röhrig, Rainer; Klasen, J.; Jost, Andreas; Benson, Matthew A.; Braun, Heinrich; Fuchs, Carsten; Hempelmann, G.

doi:10.1007/s00423-003-0398-y

Cited by 30 publications

(25 citation statements)

References 20 publications

(31 reference statements)

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“…3), whereas patients with a moderate duration of elevated HR (16 -45% of time spent in ICU) were at highest risk to develop cardiac complications. The significance of HR as an independent predictor of adverse outcomes was emphasized in recent studies demonstrating that intraoperative tachycardia in major noncardiac surgery patients is associated with an increased mortality, higher ICU admission rate, and prolonged hospital stay (5,6). Furthermore, in patients with septic shock, an initial HR of Ͻ106 beats/min and, 24 hrs after onset of shock, an HR of Ͻ95 beats/ min have been shown to be a significant predictor of survival (26).…”

Section: Discussionmentioning

confidence: 96%

“…It is well recognized that an elevation of HR in the presence of stable coronary artery stenosis causes impairment of subendocardial/ epicardial blood flow distribution because of the shortening of the diastolic time interval and, thus, may cause subendocardial ischemia and myocardial dysfunction (2). Several lines of evidence support a consistent association between HR and perioperative cardiovascular mortality in patients with a high risk for cardiac events (3)(4)(5)(6). Studies have shown that these patients have a high rate of tachycardia and asymptomatic ischemia in the early postoperative period, with ischemia almost universally preceding myocardial infarction (MI) and other cardiac complications (7,8).…”

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confidence: 98%

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Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications*

Sander

Welters

Foëx

et al. 2005

Critical Care Medicine

112

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 98%

Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications*

Sander

Welters

Foëx

et al. 2005

Critical Care Medicine

112

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“…Another important matter regarding the low specificity of TTA analysis could be superior hemostatic control in the TTA group where 50% had a pneumatic tourniquet applied during surgery. This lower intraoperative blood loss significantly[16] and potentially reduces the risk of intraoperative tachycardia[17]. Most acute LEA procedures are performed with a TFA approach[18], which to some extent is backed by the results from registration of the blood lactate and acid-base balance.…”

Section: Discussionmentioning

confidence: 99%

Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

Wied

Foss

Kristensen

et al. 2016

WJO

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AIMTo assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODSThis was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTSA logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0.004] and for the TFA sub-group [OR = 3.82 (1.5-9.42), P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648 (0.562-0.733), P = 0.001], for TFA patients = [0.710 (0.606-0.813), P < 0.001] and for TTA patients = [0.472 (0.383-0.672), P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSIONSAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

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“…The SAS value would be higher by avoding higher HR, hypotension and applying surgical techingue to minimize the bleeding. Hence, we also observed that maintaining intraoperative stability of the vital signs and controlling the bleeding are relevant predictors of the patient's final outcome (19,20).…”

Section: Discussionmentioning

confidence: 62%

Implementing the Surgical Apgar Score in patients with trauma hip fracture

Sakan

Pavlović

Milošević

et al. 2015

Injury

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Intra-operative tachycardia and peri-operative outcome

Abstract: In this study, patients with intra-operative tachycardia who were undergoing non-cardiac surgery had a greater peri-operative risk, leading to increased mortality, greater frequency of admission to an ICU and prolonged hospital stay.

Cited by 30 publications

References 20 publications

Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications*

Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications*

Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

Implementing the Surgical Apgar Score in patients with trauma hip fracture

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