[Preoperative evaluation of coronary circulation]

[Postoperative mortality a university Department of General Surgery: incidence of cardiac-related deaths]

OBJECTIVES

To evaluate the incidence of cardiac deaths following noncardiac nonvascular surgery.

STUDY DESIGN

Retrospective survey.

PATIENTS

All patients undergoing mainly endocrinous and digestive surgery in a University department of general surgery between 1991 and 1996.

METHODS

Analysis of all deaths occurring intra- and postoperatively, until discharge of the patients. Demographic and medical data, including patent myocardial ischaemia and risk factors for coronary artery disease, were recorded and compared with a control group including all patients undergoing surgery from January to September 1996.

RESULTS

In the 8,700 patients who underwent mainly endocrine neck surgery (66%), or intra-abdominal surgery (31%), the mortality rate (n = 96) was 1.1% (95% confidence interval [95% CI] = 0.9-1.3%). Patent myocardial ischaemia or high risk factors for coronary artery disease were existing in 24% of patients with neck surgery, 31% of those with intra-abdominal surgery, and in 60% of the deceased patients (P < 0.01 vs control group). Those who died were older, were in a higher ASA physical class, and had undergone an emergency procedure more often than patients of the control group (P < 0.002 for each parameter). Two cardiac deaths, in patients with a patent cardiopathy, were recorded (cardiac mortality: 0.02%; 95% CI = 0.003-0.08%). The main cause of death was infection (n = 46), followed by haemorrhage (n = 12). Seven deaths remained unexplained.

CONCLUSION

This study suggests that cardiac morbidity is a rare cause of death after noncardiac nonvascular surgery.