Usefulness of surgical parameters as predictors of postoperative cardiac events in patients undergoing non-cardiac surgery

Abstract

Background: Postoperative cardiac events are an important cause of morbidity and mortality in patients undergoing non-cardiac surgery. Predictive values of surgical parameters with respect to development of postoperative cardiac events have not been well investigated. Methods and Results: This study included 1,016 consecutive patients who underwent cardiac consultation prior to elective non-cardiac surgery. A major adverse cardiac event (MACE) was defined as a composite of all-cause death, non-fatal myocardial infarction, and pulmonary edema within 30 days of surgery. There were 95 postoperative MACEs (9.4%). Patients with postoperative MACE were significantly older, and had significantly higher revised cardiac risk index than those without. ST-T change on electrocardiogram (ECG) was significantly higher in patients with postoperative MACE. Of the surgical parameters, significant differences in surgery time (317±211 min vs. 189±112 min, P<0.001), postoperative hemoglobin (10.7±1.9 g/dl vs. 11.3±1.8 g/dl, P=0.007), risk of surgery (P<0.001), and transfusion (37.6% vs. 6.6%, P<0.001) were observed between the 2 groups. On multivariate logistic regression analysis, surgery time (odds ratio [OR], 1.004; 95% confidence interval [CI]: 1.003-1.006, P<0.001) and need for transfusion (OR, 4.578; 95% CI: 2.599-8.065, P<0.001), as well as age and ST-T change on ECG were independent predictors of postoperative MACE. Conclusions: Surgical parameters, including surgery time and transfusion, can strongly predict development of postoperative MACE in patients undergoing non-cardiac surgery.