The Potential Preventability of Postoperative Myocardial Infarction

Lindenauer, Peter K.; Fitzgerald, J; Hoople, Nancy E.; Benjamin, Evan M.

doi:10.1001/archinte.164.7.762

Cited by 45 publications

(5 citation statements)

References 34 publications

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“…The literature about the effectiveness of beta-blocker administration is mixed. 33,34 While some studies document advantages for high risk patients 35 , subgroups analyses of broader population groups failed to confirm the benefit of perioperative beta-blockers, specifically suggesting harm in low risk patients. 34 …”

Section: Discussionmentioning

confidence: 99%

Differences in Perioperative Care at Low- and High-Mortality Hospitals with Cancer Surgery

et al. 2014

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Objective To evaluate adherence to perioperative processes of care associated with major cancer resections. Summary Background Data Mortality rates associated with major cancer resections vary across hospitals. Because mechanisms underlying such variations are not well established, we studied adherence to perioperative care processes. Methods 1,279 hospitals participating in the National Cancer DataBase (2005-2006) were ranked on a composite measure of mortality for bladder, colon, esophagus, stomach, lung and pancreas cancer operations. We sampled hospitals from among those with the lowest and highest mortality rates, 19 low mortality hospitals (LMHs, risk-adjusted mortality rate 2.84%) and 30 high mortality hospitals (HMHs, risk-adjusted mortality rate 7.37%). We then conducted onsite chart reviews. Using logistic regression we examined differences in perioperative care, adjusting for patient and tumor characteristics. Results Compared to LMHs, HMHs were less likely to use prophylaxis against venous thromboembolism, either preoperative or postoperatively (aRR 0.74, 95%CI 0.50-0.92 and aRR 0.80, 95%CI 0.56-0.93, respectively). The two hospital groups were indistinguishable with respect to processes aimed at preventing surgical site infections, such as the use of antibiotics prior to incision (aRR 0.99, 95%CI 0.90-1.04), and processes intended to prevent cardiac events, including use of β-blockers (1.00, 95%CI 0.81-1.14). HMHs were significantly less likely to use epidurals (aRR 0.57, 95%CI 0.32-0.93). Conclusions HMHs and LMHs differ in several aspects of perioperative care. These areas may represent opportunities for improving cancer surgery quality at hospitals with high mortality.

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Section: Discussionmentioning

confidence: 99%

Differences in Perioperative Care at Low- and High-Mortality Hospitals with Cancer Surgery

et al. 2014

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“…[18][19][20][21] Stimulation of $ 1 receptors by catecholamines causes a positive chronotropic and inotropic effect on the heart, thus increasing the rate and contractility. $-Blockers block the action of catecholamines (epinephrine and norepinephrine) on $-adrenergic receptors.…”

Section: Pharmacologymentioning

confidence: 99%

“…3,18,19 There have also been retrospective studies finding that less than 40% of patients who could have benefited from the use of $-blockers actually received them. 3,18,19 There have also been retrospective studies finding that less than 40% of patients who could have benefited from the use of $-blockers actually received them.…”

Section: Implications For Practicementioning

confidence: 99%

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Dimensions of Critical Care Nursing

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As the population ages, more surgeries are performed on patients with increased risk factors. Many of these surgeries will result in complications and mortality. Myocardial ischemia is often associated with cardiac complications in the perioperative patient. Unfortunately, an episode of myocardial ischemia will result in a 70% mortality rate. Perioperative patients are complex because of their atypical presentation, incisional pain, and the effects of analgesia. The critical care nurse must be able to determine a patient's risk factors and surgical risks and then take measures to ensure that the patient receives adequate treatment both before and after surgery. $-Blockers may decrease a patient's risk of developing myocardial ischemia, yet they are often underused. A multidisciplinary approach is needed to ensure the proper use of $-blockers in an effort to reduce cardiac complications in the perioperative elderly patient.

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“…PMI is clinically a very significant occurrence, associated with prolonged hospital stay, substantial morbidity and mortality rates as high as 25 to 40% [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Use of ivabradine and atorvastatin in emergent orthopedic lower limb surgery and computed tomography coronary plaque imaging and novel biomarkers of cardiovascular stress and lipid metabolism for the study and prevention of perioperative myocardial infarction: study protocol for a randomized controlled trial

Rudd

Subiakto

Haq

et al. 2014

Trials

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BackgroundThe incidence of perioperative myocardial infarction (PMI) globally is known to be around 2 to 3% and can prolong hospitalization, increased morbidity and mortality. Little is known about the pathophysiology and risk factors for PMI. We investigate the presence of elevated novel cardiac markers and preoperative coronary artery plaque through contemporary laboratory techniques to determine the correlation with PMI, as well as studying ivabradine and atorvastatin as protective pharmacotherapies against PMI in the context of orthopedic surgery.Methods/DesignWe aim to enroll 200 patients aged above 60 years who suffer from neck of femur fracture requiring surgery. Patients will be randomized to four arms (no study drugs, atorvastatin only, ivabradine only and ivabradine and atorvastatin). Our primary outcome is incidence of PMI. All patients will receive an electrocardiogram, cardiac echocardiography, measurement of novel cardiac biomarkers and computed tomography (CT) coronary angiography. A telephone interview post discharge will be conducted at 30 days, 60 days and 1 year.DiscussionWe postulate that ivabradine and atorvastatin will reduce the rate and magnitude of PMI following surgery by reducing heart rate and attenuating catecholamine-induced tachycardia postoperatively. Secondly, we postulate that postoperative reduction in heart rate and catecholamine-induced tachycardia with ivabradine will correlate with a reduction in cardiovascular novel biomarkers which will reduce atrial stretch and postoperative incidence of arrhythmia. We aim to demonstrate that treatment with ivabradine and atorvastatin will cause a reduction in the incidence and magnitude of PMI, the benefit of which is derived primarily in patients with greater atherosclerotic burden as measured by higher CT coronary calcium scores.Trial registrationThis study protocol has been listed in the Australia New Zealand Clinical Trial Registry (registration number: ACTRN12612000340831) on 23 March 2012.

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The Potential Preventability of Postoperative Myocardial Infarction

Cited by 45 publications

References 34 publications

Differences in Perioperative Care at Low- and High-Mortality Hospitals with Cancer Surgery

Differences in Perioperative Care at Low- and High-Mortality Hospitals with Cancer Surgery

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