Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

BACKGROUND: Perioperative myocardial injury (MI) and MI after noncardiac surgery (MINS) makes a significant contribution to the structure of complications and mortality in non-cardiac surgery, including those in traumatology. Spinal anesthesia (SA) is usually used for hip surgery. It may be accompanied by arterial hypotension, which, under certain conditions, becomes a leading factor in MI development. Features of both hypotension and MI in patients with concomitant cardiovascular pathology operated on for hip injury remain insufficiently studied. AIM: To determine the frequency of intraoperative arterial hypotension and MI after intraosseous osteosynthesis of the hip under spinal anesthesia in patients with concomitant cardiovascular pathology. MATERIAL AND METHODS: In 275 patients with concomitant cardiovascular pathology, intraosseous synthesis of the hip was performed with SA. The functional class of the patients was assessed according to the American Society of Anesthesiologists scale and the risk of cardiac complications according to the Revised Cardiac Risk Index scale. Blood pressure, heart rate, electrocardiogram, and ST segment were monitored. Before surgery and 13 days thereafter, the troponin T level was measured. The frequency of MI and surgical outcomes were assessed. RESULTS: In the studied sample of patients with hypertonic disease, arterial hypotension associated with SA was observed in 34.2% of cases. Its frequency increased from 15.7% in patients without other comorbidities to 42.9% in patients with a combination of hypertonic disease, CAD, and CHF. A significant relationship was noted between arterial hypotension and MI. A highly sensitive troponin test revealed a significant incidence of myocardial damage (18.2%), and the associated 3-day mortality was 4%. CONCLUSION: SA-induced arterial hypotension is associated with MI risk and appears to be the most dangerous in patients with a combination of hypertonic disease, CAD, and CHF. Monitoring of troponin T levels in patients with risk factors of MI is one of the ways to reduce postoperative mortality and improve surgery outcomes.

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Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

Kutchev

Shulenin

Solovyev

et al. 2023

Bulletin of the Russian Military Medical Academy

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This retrospective study analyzed the structure of complications and mortality cases in 351 patients (men, n = 199; women, n = 152) aged 3389 years with locally advanced abdominal cancer and different cardiovascular risks in the early postoperative period, and two patient groups were formed. The main group consisted of 81 (23.1%) patients who died in the early postoperative period. The comparison group included 270 (76.9%) patients. In total, 311 (88.6%) patients underwent radical surgical intervention, whereas 40 (11.4%) underwent minimally invasive surgical treatment. Perioperative cardiovascular risk was stratified by calculating cardiac risk indices and using the database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest. Fatal complications in the early postoperative period after surgical treatment of locally advanced abdominal cancer is significantly more often observed in patients with a more pronounced degree of tumor invasion, lymph node lesions, high class according to the standards of the American Society of Anesthesiologists, reduced functional status, prior hormone therapy, and combined anesthesia. The majority of fatal cases were associated with three complications, i.e., ventricular arrhythmias (53%), acute decompensation of heart failure (46%), and multiple organ failure (43%). Approximately 95% of deaths were associated with increased postoperative cardiovascular risk, and 52% were medium-risk cases. Hospital mortality at low risk was noted in 4.9%, average in 27.8%, and high in 32.7% of the patients. In cases with a favorable course, surgical complications were predominant over cardiovascular ones. The use of calculated cardiac risk indices and database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest confirmed their high ability to predict the development of cardiovascular complications, which are the leading causes of death in the early postoperative period in patients who underwent surgical interventions for locally advanced abdominal cancer.

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Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Cited by 7 publications

References 32 publications

Accuracy of predictors of perioperative cardiovascular complications in onco-surgery

Accuracy of predictors of perioperative cardiovascular complications in onco-surgery

Myocardial injury in patients with hypertonic disease at osteosynthesis of the hip and spinal anesthesia

Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

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