Prognostic value of perioperative N-terminal pro-B-type natriuretic peptide in noncardiac surgery

Abstract

NT-proBNP is a powerful short-term marker of perioperative cardiovascular events in high risk patients. Postoperative levels were less informative than preoperative levels. A single preoperative NT-proBNP measurement should be considered in the preoperative risk assessment.

Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

“…In total, 24 of the 28 studies 29,[34][35][36][37][38][40][41][42][43][46][47][48][49][50][51][52][53][55][56][57][58][59][60] were prospective observational cohort studies. Of the remaining four studies: …”

“…Of the remaining studies, three reported exclusively on patients undergoing emergency surgery, 38,45,48 and one documented both elective and emergency surgeries that were classified as being high risk. 46 Certain studies investigated outcomes in a specific surgical discipline, including thoracic surgery (4), 36,50,51,54 vascular (7), 29,40,42,44,55,57,59 orthopaedic (5), 45,[47][48][49]60 major abdominal (1), 56 oesophagectomy (1), 41 while the rest documented outcomes following a variety of surgeries performed (10), 34,35,[37][38][39]43,46,52,53,58 including a mix of general, head and neck, gynaecological, orthopaedic, vascular, urological, neurosurgery and thoracic surgery.…”

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

“…Most of the studies evaluating BNPs had levels drawn within 2 weeks prior to the day of surgery, typically at one time-point, however recent studies have incorporated perioperative BNP levels (levels drawn preoperatively and up to 5 days following surgery) [36,38,43,[45][46]. Preoperative BNPs have been found to be an independent predictor or associated with increased postoperative cardiac events [35][36][37][38][39][40][41][42][43][44]47,142] or mortality [24,41,[46][47] in noncardiac surgery, including cardiac morbidity at 30 days following discharge from hospitalization [38].…”

“…Studies measuring BNPs in patients undergoing noncardiac surgery have investigated the role in the perioperative period for risk prediction or associations with adverse postoperative myocardial events [35][36][37][38][39][40][41][42][43][44], prolonged hospital stay [45] and mortality [24,[46][47] (see Table 4). Most of the studies evaluating BNPs had levels drawn within 2 weeks prior to the day of surgery, typically at one time-point, however recent studies have incorporated perioperative BNP levels (levels drawn preoperatively and up to 5 days following surgery) [36,38,43,[45][46].…”

“…Preoperative BNPs have been found to be an independent predictor or associated with increased postoperative cardiac events [35][36][37][38][39][40][41][42][43][44]47,142] or mortality [24,41,[46][47] in noncardiac surgery, including cardiac morbidity at 30 days following discharge from hospitalization [38]. Additionally, postoperative BNPs [36,45] were associated with cardiac events, but not always [47], and predictive for mortality over a 2-year follow-up [47]. These findings were typically representative of patients who were aged 60 years and older with cardiovascular co-morbidities.…”