Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Abstract

To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.

Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study

“…In the last 30 years, there have been some risk indicators based on multivariate analysis of observational data, which express the relationship between clinical characteristics and perioperative mortality and morbidity from cardiac causes or perioperative complications [12]. The popular schemes were developed by Goldman et al [13], Detsky et al [14], and Lee et al [15].…”

Comparison of Individual Urologists’ Performance

“…A similar technique has been used by others to assess risk factors [13]. The information obtained from this analysis was combined with both linear discriminant and logistic regression analysis to produce the present physiological and operative severity score [2].…”

The measurement of adult blood pressure and management of hypertension before elective surgery

“…Systolic blood pressures in excess of 170 mmHg and diastolic blood pressures in excess of 110 mmHg were associated with complications such as myocardial ischaemia 11. Hypertension was the second‐most common factor associated with postoperative morbidity 12.…”