Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study

Ackland, Gareth L.; Harris, Steve; Ziabari, Y; Grocott, Michael P.W.; Mythen, Michael G.

doi:10.1093/bja/aeq245

Cited by 56 publications

(47 citation statements)

References 35 publications

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“…(ii) surgical procedures with an estimated or documented risk of postoperative morbidity (as defined by the PostOperative Morbidity Survey) exceeding 50%; and (iii) modified Revised Cardiac Risk Score ≥3, 13 as defined by age ≥70 yr, a history of cardiovascular disease (myocardial infarction, coronary artery disease, cerebrovascular accident, ECG evidence for established cardiac pathology), cardiac failure, poor exercise capacity (anaerobic threshold <11 ml kg min −1 as assessed by cardiopulmonary exercise testing), renal impairment (serum creatinine ≥130 µmol l −1 ), or diabetes mellitus. Intraoperative management was undertaken by consultant anaesthetists, according to their usual practice.…”

Section: Methodsmentioning

confidence: 99%

Baroreflex impairment and morbidity after major surgery

Toner

Jenkins

Ackland

2016

British Journal of Anaesthesia

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Background: Baroreflex dysfunction is a common feature of established cardiometabolic diseases that are most frequently associated with the development of critical illness. Laboratory models show that baroreflex dysfunction impairs cardiac contractility and cardiovascular performance, thereby increasing the risk of morbidity after trauma and sepsis. We hypothesized that baroreflex dysfunction contributes to excess postoperative morbidity after major surgery as a consequence of the inability to achieve adequate perioperative tissue oxygen delivery. Methods: In a randomized controlled trial of goal-directed haemodynamic therapy (GDT) in higher-risk surgical patients, baroreflex function was assessed using the spontaneous baroreflex sensitivity (BRS) method via an arterial line placed before surgery, using a validated sequence method technique (one beat lag). The BRS was calculated during the 6 h postoperative GDT intervention. Analyses of BRS were done by investigators blinded to clinical outcomes. The primary outcome was the association between postoperative baroreflex dysfunction (BRS <6 mm Hg s −1 , a negative prognostic threshold in cardiovascular

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Section: Methodsmentioning

confidence: 99%

Baroreflex impairment and morbidity after major surgery

Toner

Jenkins

Ackland

2016

British Journal of Anaesthesia

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“…Perioperative cardiovascular complications are a major cause of morbidity, mortality, and increased length of hospital stay for patients undergoing elective orthopedic procedures [26]. High preoperative cardiac risk can even increase the risk of non-cardiac complications in these patients [26].…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…High preoperative cardiac risk can even increase the risk of non-cardiac complications in these patients [26]. It is important for patients to undergo a full cardiac workup prior to surgery if there is any suspicion of cardiac abnormalities.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Sveom¹,

Otteman²,

Garvin³

2017

Curr Rev Musculoskelet Med

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Purpose of review Total joint arthroplasty (TJA) has had an increased demand over the recent years. It is a successful procedure, and there are relatively few complications, but there is a high overall cost. There is a push to increase the quality of care, lessen complications, and decrease cost by reducing readmissions. This article will discuss the risk factors that can contribute to the complication and readmission rates following TJA. Recent findings Several risk factors have been found to contribute to the complication and readmission rates following a TJA. It is important to understand these risk factors and mitigate them as much as possible in order to optimize the patient experience. There are risk factors that cannot be modified, and the treatment team as well as the patient should be made aware of these and account for them when making the decision whether to undergo elective primary TJA or not. In general, an increased number of risk factors is associated with increased complications and increased readmission rates. At our institution, we have used this knowledge to improve our outcomes and decrease costs. Summary It is important to be mindful of risk factors for poor outcomes prior to performing TJA. This allows for the optimization of patients prior to undergoing surgery. This can lead to improved outcomes at a lower cost.

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“…The same study also found that in patients with multiple complications, a MI was often the sentinel event. Another prospective study of 560 patients undergoing elective primary and revision hip and knee procedures showed a significant correlation between elevated preoperative cardiac risk index score and non-cardiac complications (RR 1.7) [16].…”

Section: Discussionmentioning

confidence: 99%

Impact of preoperative myocardial infarction on surgical outcomes in inpatient orthopaedic surgery

Lim

Edelstein

Jain

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the impact of a preoperative myocardial infarction (MI) on outcomes of inpatient orthopaedic operations. Methods The National Surgical Quality Improvement Program database was used to identify patients who underwent common orthopaedic operations from 2006 to 2010. Patient demographic data, comorbidities, complications, and lengths of stay were collected. Multivariate logistic regression and linear regression models were used to compare outcomes for patients with and without a history of MI in the six months prior to surgery. Results Of the 32,462 patients identified, 86 had sustained an MI in the six months prior to surgery. The MI cohort had no cardiac complications but had increased incidences of superficial surgical site infection, unplanned re-intubation, ventilator-assisted respiration for more than 48 hours, pneumonia, sepsis or septic shock, and postoperative mortality within 30 days of surgery, as well as prolonged lengths of stay. Following logistic regression to adjust for baseline differences, a history of MI showed no association with cardiac complications and was significantly associated with superficial surgical site infection (OR 3.6, 95 % CI 1.1-11.8), ventilator dependence for over 48 hours (OR 4.0, 95 % CI 1.1-14.0), and extended length of stay (median with interquartile range 4 [4-4] vs. 5 days).Conclusions A myocardial infarction within six months prior to orthopaedic surgery is not associated with a higher risk of 30-day perioperative cardiac complications; however, it is associated with increased rates of surgical site infection, prolonged ventilator dependence, and longer hospital stay.

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Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study

Abstract: mRCRI score ≥ 3 is associated with increased postoperative non-cardiac morbidity and prolonged hospital stay after elective orthopaedic procedures. mRCRI can contribute to objective risk stratification of postoperative morbidity.

Cited by 56 publications

References 35 publications

Baroreflex impairment and morbidity after major surgery

Baroreflex impairment and morbidity after major surgery

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Impact of preoperative myocardial infarction on surgical outcomes in inpatient orthopaedic surgery

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