Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery

Park, Jungchan; Kwon, Ji‐Hye; Lee, Seung Hwa; Lee, Jong Hwan; Min, Jeong Jin; Kim, Jihoon; Oh, Ah Ran; Seo, Wonho; Hyeon, Cheol Won; Yang, Kwangmo; Choi, Jin-Ho; Lee, Sang‐Chol; Kim, Kyunga; Ahn, Joonghyun; Gwon, Hyeon Cheol

doi:10.1371/journal.pone.0241114

Cited by 14 publications

(9 citation statements)

References 25 publications

(10 reference statements)

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“…In the study by Jungchan Park et al in 2021, intraoperative hemoglobin levels below 7g/L or less than 50% were de ned as signi cant intraoperative bleeding. Compared to the group without signi cant intraoperative bleeding, signi cant intraoperative bleeding group had an increased risk of AMI(OR:1.58, 95%Cl:1.43-1.75) [14]. Our results treated intraoperative bleeding as a continuous variable, and the risk of AMI was 1.003(95% Cl: 1.001-1.004).…”

Section: Discussionmentioning

confidence: 53%

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

Ran,

Yu,

et al. 2024

Preprint

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Introduction: This article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients. Methods This article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Collect their demographic data, laboratory examination indicators, and imaging examination results from medical case system. Using univariate and multivariate logistic regression to determine the risk factors for postoperative AMI, establishing the nomogram prediction model, drawing ROC curves, calibration curves, and DCA decision curves by using R language. At the same time, the patients in the training set were followed up for 2 years to evaluate their survival situation. Results 1094 eligible patients divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.4 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166(20.1%) patients underwent percutaneous coronary intervention(PCI); Hypertension accounted for 55.7%; 520(63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36g/L; The average intraoperative bleeding volume was 212.42ml; The average surgical time was 2.2 ± 0.3 hours; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68(73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, what else, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation. Conclusion Our research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.

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Section: Discussionmentioning

confidence: 53%

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

Ran,

Yu,

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…The need for intraoperative inotropic drug infusion and red blood cell transfusion also might be related to hypotension or anemia, www.nature.com/scientificreports/ which is associated with a higher risk of MINS [18][19][20] . In addition, transfusions per se could act as an additional burden 21,22 . On the other hand, this may also be due to pre-existing anemia, and this needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

Prediction model for myocardial injury after non-cardiac surgery using machine learning

Park

Shin

et al. 2023

Sci Rep

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Myocardial injury after non-cardiac surgery (MINS) is strongly associated with postoperative outcomes. We developed a prediction model for MINS and have provided it online. Between January 2010 and June 2019, a total of 6811 patients underwent non-cardiac surgery with normal preoperative level of cardiac troponin (cTn). We used machine learning techniques with an extreme gradient boosting algorithm to evaluate the effects of variables on MINS development. We generated two prediction models based on the top 12 and 6 variables. MINS was observed in 1499 (22.0%) patients. The top 12 variables in descending order according to the effects on MINS are preoperative cTn level, intraoperative inotropic drug infusion, operation duration, emergency operation, operation type, age, high-risk surgery, body mass index, chronic kidney disease, coronary artery disease, intraoperative red blood cell transfusion, and current alcoholic use. The prediction models are available at https://sjshin.shinyapps.io/mins_occur_prediction/. The estimated thresholds were 0.47 in 12-variable models and 0.53 in 6-variable models. The areas under the receiver operating characteristic curves are 0.78 (95% confidence interval [CI] 0.77–0.78) and 0.77 (95% CI 0.77–0.78), respectively, with an accuracy of 0.97 for both models. Using machine learning techniques, we demonstrated prediction models for MINS. These models require further verification in other populations.

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“…and immunocompromise is warranted. 4,29,30 We emphasize our study was comprised of mostly healthy patients and postoperative complications in both groups were infrequent, which may have led to relative contraindications to blTHA going unrecognized.…”

Section: Discussionmentioning

confidence: 97%

A NSQIP Analysis of Complications after Simultaneous Bilateral Total Hip Arthroplasty

Rezzadeh

Nigh

Debbi

et al. 2023

The Journal of Hip Surgery

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Simultaneous bilateral total hip arthroplasty (blTHA) offers the benefit of a single episode of care with the potential for lower cumulative operative times and rehabilitation periods than staged bilateral total hip arthroplasty (stTHA). This study analyzes short-term complication rates after blTHA relative to unilateral THA (ulTHA) and projected stTHA in patients with bilateral hip osteoarthritis. We compared complications in a simultaneous blTHA group and a ulTHA group using the National Surgical Quality Improvement Program (NSQIP) database. ulTHA patients were propensity-matched two-to-one against blTHA patients using morbidity probability score. Thirty-day complication rates were compared. Outcomes in staged procedures (stTHA) were projected by doubling complication rates in ulTHA procedures. There were 805 blTHA patients and 1,610 ulTHA patients used to estimate stTHA outcomes. The rate of major complications or death after blTHA was no higher than the projected stTHA rate (2.0 vs 3.0%, p = 0.179), but minor complications were more common after blTHA than stTHA projections (13.5 vs 6.8%, p < 0.001). Mean operative time for blTHA was 39.2 minutes shorter than that for stTHA (p < 0.001); mean hospital stay was 1 day shorter for blTHA than that for stTHA (p < 0.001). Thirty-day rates of periprosthetic fracture (0.62 vs 0.12%, p = 0.045) and dislocation (0.50 vs 0.1%, p = 0.1) were higher after blTHA than stTHA. Simultaneous blTHA appears safe in patients medically fit to tolerate longer uninterrupted surgery and appears to shorten operative time and hospital stay relative to staged THA. There is a significantly higher risk of blood transfusion, periprosthetic fracture, and dislocation after blTHA.

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Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery

Cited by 14 publications

References 25 publications

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

Prediction model for myocardial injury after non-cardiac surgery using machine learning

A NSQIP Analysis of Complications after Simultaneous Bilateral Total Hip Arthroplasty

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