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Coviello A, Cirillo D, Vargas M, de Siena AU, Barone MS, Esposito F, Izzo A, Buonanno P, Volpe S, Stingone AG, Iacovazzo C. Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study. J Clin Med 2024; 13:3511. [PMID: 38930041 PMCID: PMC11204530 DOI: 10.3390/jcm13123511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The assessment of cardiac risk is challenging for elderly patients undergoing major orthopedic surgery with preoperative functional limitations. Currently, no specific cardiac risk scores are available for these critical patients. Echocardiography may be a reliable and safe instrument for assessing cardiac risks in this population. This study aims to evaluate the potential benefits of echocardiography in elderly orthopedic patients, its impact on anesthesiologic management, and postoperative Major Adverse Cardiac Events (MACEs). Methods: This is a retrospective, one-arm, monocentric study conducted at ''Federico II'' Hospital-University of Naples-from January to December 2023, where 59 patients undergoing hip or knee revision surgery under neuraxial anesthesia were selected. The demographic data, the clinical history, and the results of preoperative Echocardiography screening (pEco-s) were collected. After extensive descriptive statistics, the χ2 test was used to compare the valvopathies and impaired Left Ventricular Function (iLVEF) prevalence before and after echocardiography screening and the incidence of postoperative MACE; a p-value < 0.05 was considered statistically significant. Results: The mean age was 72.5 ± 6.9, and the prevalence of cardiac risk factors was about 90%. The cumulative prevalence of iLVEF and valvopathy was higher after the screening (p < 0.001). The pEco-s diagnosed 25 new valvopathies: three of them were moderate-severe. No patients had MACE. Conclusions: pEco-s evaluation could discover unknown heart valve pathology; more studies are needed to understand if pEco-s could affect the anesthetic management of patients with functional limitations, preventing the incidence of MACE, and assessing its cost-effectiveness.
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Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Uriel de Siena
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Silvia Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Francesco Esposito
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Antonio Izzo
- Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, “Federico II”—University of Naples, 80100 Naples, Italy;
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Serena Volpe
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Gabriele Stingone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
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Yan Y, Barbati ME, Avgerinos ED, Doganci S, Lichtenberg M, Jalaie H. Elevation of cardiac enzymes and B-type natriuretic peptides following venous recanalization and stenting in chronic venous obstruction. Phlebology 2024:2683555241261321. [PMID: 38862920 DOI: 10.1177/02683555241261321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO). OBJECTIVES The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO. METHODS This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1 day before and 1 day after venous intervention. Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels. RESULTS Median concentration of post-operative BNP (259.60 pg/mL) was greater than preoperative levels (49.80 pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3 U/l (IQR, 1.40/11.00) versus postop: 14 U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00 pg/mL (IQR, 3.00/5.25) versus postop: level of 6 pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05). Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p < 0.05). CONCLUSIONS Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions.
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Affiliation(s)
- Yan Yan
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Mohammad E Barbati
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Efthymios D Avgerinos
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
| | - Suat Doganci
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey
| | | | - Houman Jalaie
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Jennewine BR, Throckmorton TW, Pierce AS, Miller AH, Azar AT, Sharp CD, Azar FM, Bernholt DL, Brolin TJ. Patient-selection algorithm for outpatient shoulder arthroplasty in ambulatory surgery center: a retrospective update. J Shoulder Elbow Surg 2024; 33:900-907. [PMID: 37625693 DOI: 10.1016/j.jse.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Outpatient total shoulder arthroplasty (TSA) presents a safe alternative to inpatient arthroplasty, while helping meet the rapidly rising volume of shoulder arthroplasty needs and minimizing health care costs. Identifying the correct patient for outpatient surgery is critical to maintaining the safety standards with TSA. This study sought to update an ambulatory surgery center (ASC) TSA patient-selection algorithm previously published by our institution. METHODS A retrospective chart review of TSAs was performed in an ASC at a single institution to collect patient demographics, perioperative risk factors, and postoperative outcomes with regard to reoperations, hospital admissions, and complications. The existing ASC algorithm for outpatient TSA was altered based on collected perioperative information, review of pertinent literature, and anesthesiology recommendations. RESULTS A total of 319 TSAs were performed in an ASC in 298 patients over 7 years. Medically related complications occurred in 3 patients (0.9%) within 90 days of surgery, 2 of whom required hospital admission (0.6%) for acute kidney injury and pulmonary embolus. There were no instances of major cardiac events. Orthopedic-related complications occurred in 11 patients (3.4%), with hematoma development requiring evacuation and instability requiring revision being the most common causes. CONCLUSIONS There was a low rate of perioperative complications and hospital admissions, confirming the safety of TSAs in an ASC setting. Based on prior literature and the population included, a pre-existing patient-selection algorithm was updated to better reflect increased comfort, knowledge, and data regarding safe patient selection for TSA in an ASC.
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Affiliation(s)
- Brenton R Jennewine
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Andrew S Pierce
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Andrew H Miller
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adrian T Azar
- College of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - David L Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
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Khalifa AA, Khidr SS, Hassan AAA, Mohammed HM, El-Sharkawi M, Fadle AA. Can Orthopaedic Surgeons adequately assess an Electrocardiogram (ECG) trace paper? A cross sectional study. Heliyon 2023; 9:e22617. [PMID: 38046166 PMCID: PMC10686838 DOI: 10.1016/j.heliyon.2023.e22617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives The primary objective was to evaluate the ECG trace paper evaluation current knowledge level in a group of Orthopaedic surgeons divided into juniors and seniors according to M.D. degree possession. Methods A cross sectional study through self-administered questionnaires at a university hospital Orthopaedic and Trauma Surgery Department. The questionnaire included five sections: 1-Basic participants' characteristics, 2-Participants' perception of their ECG evaluation current knowledge level, 3-The main body of the questionnaire was an ECG quiz (seven); the participant was asked to determine if it was normal and the possible diagnosis, 4-Participants' desired ECG evaluation knowledge level, and 5-Willingness to attend ECG evaluation workshops. Results Of the 121 actively working individuals in the department, 96 (97.3 %) finished the questionnaire, and 85 (77.3 %) were valid for final evaluation. The participants' mean age was 30.4 ± 6.92 years, 76.5 % juniors and 23.5 % seniors. 83.5 % of the participants perceived their current ECG evaluation knowledge as none or limited. For participants' ability to evaluate an ECG, higher scores were achieved when determining if the ECG was normal or abnormal, with a mean score percentage of 79.32 % ± 23.27. However, the scores were lower when trying to reach the diagnosis, with a mean score percentage of 43.02 % ± 27.48. There was a significant negative correlation between the participant's age and answering the normality question correctly (r = -0.277, p = 0.01); and a significant positive correlation between answering the diagnosis question correctly and the desired level of knowledge and the intention to attend a workshop about ECG evaluation, r = 0.355 (p = 0.001), and r = 0.223 (p = 0.04), respectively. Only 56.5 % of the participants desired to get more knowledge, and 81.2 % were interested in attending ECG evaluation workshops. Conclusion Orthopaedic surgeons showed sufficient knowledge when determining the normality of ECG trace papers; however, they could not reach the proper diagnosis, and Junior surgeons performed slightly better than their senior peers. Most surgeons are willing to attend ECG evaluation and interpretation workshops to improve their knowledge level.
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Affiliation(s)
- Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Shimaa S. Khidr
- Cardiology Department, Assiut University Hospital, Assiut, Egypt
| | | | - Heba M. Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammad El-Sharkawi
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr A. Fadle
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Predicting Postoperative Troponin in Patients Undergoing Elective Hip or Knee Arthroplasty: A Comparison of Five Cardiac Risk Prediction Tools. Cardiol Res Pract 2022; 2022:8244047. [PMID: 36275928 PMCID: PMC9586832 DOI: 10.1155/2022/8244047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty. Methods This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI). Results None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; p=0.04), ACS-NSQIP (C-statistic of 0.69; p=0.01), and RCRI (C-statistic of 0.64; p=0.04) predicted MINS. Among all patients, spearman correlations (rs) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with p values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (rs = 0.51, p=0.001). Conclusion In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.
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Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev 2021; 12:CD013139. [PMID: 34931303 PMCID: PMC8689147 DOI: 10.1002/14651858.cd013139.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this. OBJECTIVES Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. SEARCH METHODS We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period. SELECTION CRITERIA We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion. DATA COLLECTION AND ANALYSIS We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews. MAIN RESULTS We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively. AUTHORS' CONCLUSIONS Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future.
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Affiliation(s)
- Lisette M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Anesthesiologist and R. Fraser Elliott Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network and Professor, Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johanna Aag Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Vetrugno L, Boero E, Bignami E, Cortegiani A, Raineri SM, Spadaro S, Moro F, D’Incà S, D’Orlando L, Agrò FE, Bernardinetti M, Forfori F, Corradi F, Pregnolato S, Mosconi M, Bellini V, Franchi F, Mongelli P, Leonardi S, Giuffrida C, Tescione M, Bruni A, Garofalo E, Longhini F, Cammarota G, De Robertis E, Giglio G, Urso F, Bove T. Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP). Ultrasound J 2021; 13:30. [PMID: 34100124 PMCID: PMC8184059 DOI: 10.1186/s13089-021-00230-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs. METHODS LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns-each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. CONCLUSIONS Lung ultrasound (LU), as a tool within the anesthesiologist's armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Savino Spadaro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Federico Moro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Stefano D’Incà
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Loris D’Orlando
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Felice Eugenio Agrò
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Mattia Bernardinetti
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Sandro Pregnolato
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Mosconi
- Orthopedics and Traumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | - Pierpaolo Mongelli
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | | | | | - Marco Tescione
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Giglio
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Felice Urso
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
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Madsen CV, Jørgensen LN, Leerhøy B, Gögenur I, Ekeloef S, Sajadieh A, Domínguez H. <p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2020. [DOI: 10.2147/rrcc.s197407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Duceppe E, Patel A, Chan MTV, Berwanger O, Ackland G, Kavsak PA, Rodseth R, Biccard B, Chow CK, Borges FK, Guyatt G, Pearse R, Sessler DI, Heels-Ansdell D, Kurz A, Wang CY, Szczeklik W, Srinathan S, Garg AX, Pettit S, Sloan EN, Januzzi JL, McQueen M, Buse GL, Mills NL, Zhang L, Sapsford R, Paré G, Walsh M, Whitlock R, Lamy A, Hill S, Thabane L, Yusuf S, Devereaux PJ. Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study. Ann Intern Med 2020; 172:96-104. [PMID: 31869834 DOI: 10.7326/m19-2501] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. OBJECTIVE To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. DESIGN Prospective cohort study. SETTING 16 hospitals in 9 countries. PATIENTS 10 402 patients aged 45 years or older having inpatient noncardiac surgery. MEASUREMENTS All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery. RESULTS In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]). LIMITATION External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. CONCLUSION Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Emmanuelle Duceppe
- University of Montreal, Montreal, Québec, and McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (E.D.)
| | - Ameen Patel
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.C., L.Z.)
| | - Otavio Berwanger
- Hospital Israelita Albert Einstein (Academic Research Organization-ARO), Sao Paulo, Brazil (O.B.)
| | - Gareth Ackland
- Translational Medicine & Therapeutics William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (G.A., R.P.)
| | - Peter A Kavsak
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Reitze Rodseth
- University of KwaZulu-Natal, Glenwood, Durban, South Africa (R.R.)
| | - Bruce Biccard
- Groote Schuur Hospital and University of Cape Town, Western Cape, South Africa (B.B.)
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, and Westmead Hospital, Westmead, Australia (C.K.C.)
| | - Flavia K Borges
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Gordon Guyatt
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Rupert Pearse
- Translational Medicine & Therapeutics William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (G.A., R.P.)
| | | | - Diane Heels-Ansdell
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Andrea Kurz
- Cleveland Clinic, Cleveland, Ohio (D.I.S., A.K.)
| | - Chew Yin Wang
- University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.)
| | | | | | - Amit X Garg
- Western University, London, Ontario, Canada (A.X.G.)
| | - Shirley Pettit
- Population Health Research Institute, Hamilton, Ontario, Canada (S.P.)
| | - Erin N Sloan
- University of British Columbia, Vancouver, British Columbia, Canada (E.N.S.)
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, Massachusetts (J.L.J.)
| | - Matthew McQueen
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | | | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Sciences and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom (N.L.M.)
| | - Lin Zhang
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.C., L.Z.)
| | | | - Guillaume Paré
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Michael Walsh
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Richard Whitlock
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Andre Lamy
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Stephen Hill
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Lehana Thabane
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Salim Yusuf
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - P J Devereaux
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
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Guerra MTE, Giglio L, Morais JMM, Labatut G, Feijó MC, Kayser CEP. The Relationship between the Lee Score and Postoperative Mortality in Patients with Proximal Femur Fractures. Rev Bras Ortop 2019; 54:387-391. [PMID: 31435103 PMCID: PMC6701968 DOI: 10.1055/s-0039-1694020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/07/2017] [Indexed: 10/26/2022] Open
Abstract
Objective To verify the predictive value of the Lee score for mortality in a one-year period after proximal femur fracture surgery. The present study also evaluated the isolated predictive capacity of other variables. Methods A sample of 422 patients with surgically-treated proximal femur fractures was evaluated. Data was collected through a review of medical records, appointments, and contact by telephone. Results The Lee score was applied to 99.3% of the patients with proximal femur fractures submitted to surgical treatment. The mortality rate was of 22% of the sample, and the majority were classified as class I risk. The Lee score had no significant association with mortality ( p = 0.515). High levels of serum creatinine ( p = 0.001) and age ( p = 0.000) were directly associated with death. Conclusion The Lee score was not predictive of mortality in a one-year period after proximal femur fracture surgery; however, a statistical significance was observed between age and serum creatinine levels, considered separately, and death.
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Affiliation(s)
| | - Luiz Giglio
- Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
| | | | - Giovanna Labatut
- Serviço de Ortopedia e Traumatologia, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brasil
| | - Monica Cavanus Feijó
- Serviço de Ortopedia e Traumatologia, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brasil
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Adar A, Onalan O, Cakan F, Akbay E, Colluoglu T, Dasar U, Mutlu T. A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification. Heart Lung 2019; 48:446-451. [PMID: 30595343 DOI: 10.1016/j.hrtlng.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. AIM The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. METHODS Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. RESULTS A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. CONCLUSIONS Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery.
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Affiliation(s)
- Adem Adar
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey.
| | - Orhan Onalan
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Fahri Cakan
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Ertan Akbay
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Tugce Colluoglu
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Uygar Dasar
- Karabuk University Faculty of Medicine, Department of Orthopaedic Surgery, Karabuk, Turkey
| | - Tansel Mutlu
- Karabuk University Faculty of Medicine, Department of Orthopaedic Surgery, Karabuk, Turkey
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Zainudheen A, Scott IA, Caney X. Association of renin angiotensin antagonists with adverse perioperative events in patients undergoing elective orthopaedic surgery: a case-control study. Intern Med J 2018; 47:999-1005. [PMID: 28509399 DOI: 10.1111/imj.13487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/30/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Renin angiotensin antagonists (RAA) may block protective vasopressor responses during surgery. Evidence linking RAA with intraoperative hypotension and perioperative adverse events is conflicting. AIM To compare the incidence of intraoperative hypotension and adverse events between patients receiving or not receiving RAA. METHODS This is a retrospective case-control study of 258 consecutive patients who underwent elective total knee or hip replacement between 1 January 2013 and 31 August 2016 and who were chronically prescribed a single blood pressure-lowering agent up to the time of surgery. Primary outcome measures were differences between patients receiving RAA (cases; n = 129) and patients receiving non-RAA medications (controls; n = 129) in incidence of intraoperative hypotension (systolic blood pressure <90 mmHg), perioperative acute kidney injury (AKI, >30% increase in serum creatinine from baseline on Day 1 post-operatively) and new onset major adverse cardiac or cerebrovascular events (MACCE) or in-hospital death over 72 h post-operatively. RESULTS Patients receiving RAA had significantly higher preoperative systolic blood pressure, greater prevalence of hypertension and chronic kidney disease, lower prevalence of ischaemic heart disease and lower cardiac risk compared to controls. Age, gender, type of operation, operative fitness, mode and duration of anaesthesia and prevalence of other types of cardiovascular disease, dyslipidaemia and diabetes were similar between groups. Compared to controls, patients receiving RAA had higher incidence of intraoperative hypotension (76.0 vs 45.9%, P < 0.001), AKI (11.6 vs 1.6%, P = 0.002) and MACCE (6.2 vs 0%, P = 0.007), with all adverse events associated with intraoperative hypotension. CONCLUSION This study provides further observational evidence of RAA-induced harm in patients undergoing elective surgery, although determining benefits and harms of preoperative withdrawal of RRA requires prospective randomised trials.
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Affiliation(s)
- Amith Zainudheen
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Xenia Caney
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Vetrugno L, Orso D, Matellon C, Giaccalone M, Bove T, Bignami E. The Possible Use of Preoperative Natriuretic Peptides for Discriminating Low Versus Moderate-High Surgical Risk Patient. Semin Cardiothorac Vasc Anesth 2018; 22:395-402. [DOI: 10.1177/1089253217752061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative risk scores for patients undergoing noncardiac surgery are generally considered inaccurate, poor, or, at best, modest. We propose estimating a patient’s pretest and posttest probability of cardiac morbidity and death using the preoperative scoring system plus the negative likelihood ratio from brain natriuretic peptide (BNP) or N-terminal proB-type natriuretic peptide (NT-proBNP) plasma levels. Our clinical challenge scenario showed a pretest probability of postoperative major cardiac complications with the patient risk factor as 6.6% for the Revised Cardiac Risk Index and between 1% and 5% (intermediate risk) per the recent European Society of Cardiology and the European Society of Anesthesiologist guidelines for surgical risk estimation. In fact, the American College of Cardiology and the American Heart Association guidelines consider the same surgical procedure for elevated risk. The posttest probability takes advantage of a negative likelihood ratio from BNP plasma levels, with patient risk factor reduced to 0.8% and surgical risk to 1.1%. In the same way, the pretest American College of Surgeons National Surgical Quality Improvement Program score decreased from 18.8% to 3.5% for severe complications and from 0.9% to 0.1% for death at ≤90 days. Following noncardiac surgery, postoperative complications and mortality are often cardiac in nature. The negative likelihood ratio of BNP and NT-proBNP plasma levels provides a quick, low-cost tool for recognizing and reclassifying the cardiovascular risk of those undergoing noncardiac surgery, thereby singling out low- versus moderate-high-risk surgical patients.
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Long G, Hao C, Li G, Yang Y, Hongzhong Z, Zhenhu W. Predictive value of B-type natriuretic peptide (BNP) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA). J Orthop Sci 2016; 21:826-830. [PMID: 27623045 DOI: 10.1016/j.jos.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/24/2016] [Accepted: 08/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a well-known biomarker to predict cardiac events following orthopedic procedures. However, further information regarding BNP can be completed. The present study aims to determine which of preoperative, postoperative or the difference between them (DVPPB) can best predict adverse cardiac events following TKA procedure and detect possible risk factors of high level of BNP. METHODS Between Jan. 2012 and Jan. 2014. 1120 included patients in 3 institutions have a minimum of 2-years follow-up. All clinical characteristics related to TKA procedure were put in total joint arthroplasty registry system and analyzed finally. The cut-off value of BNP predicting patients at increased risks of cardiac events after TKA was evaluated by the Receiver Operating Characteristic (ROC) curve analysis. RESULTS Our results reveal DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TKA, and the optimal cut-off value was 825.5 pg/ml with the highest Youden index of 0.62. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. CONCLUSIONS DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TKA. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. We hope these results could be helpful to optimize health care among patients undergoing primary TKA.
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Affiliation(s)
- Gong Long
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Chen Hao
- Department of Cardiology, Men Tou Gou District Hospital, Beijing, 100000, China
| | - Geng Li
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Yu Yang
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Zhou Hongzhong
- Department of Orthopedics, Affiliated Hospital of Dezhou City, No.1766 San Ba Middle Road, Dezhou, Shandong, 253000, China.
| | - Wang Zhenhu
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
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Ryan L, Rajah C, Simmers D, Potgieter D, Rodseth RN. Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1075938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Katsanos S, Babalis D, Kafkas N, Mavrogenis A, Leong D, Parissis J, Varounis C, Makris K, van der Heijden A, Anastasiou-Nana M, Filippatos G. B-type natriuretic peptide vs. cardiac risk scores for prediction of outcome following major orthopedic surgery. J Cardiovasc Med (Hagerstown) 2015; 16:465-71. [DOI: 10.2459/jcm.0000000000000210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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