TY - JOUR
T1 - Reevaluating the Cardiac Risk of Noncardiac Surgery Using the National Surgical Quality Improvement Program
AU - Peterson, Brandon R.
AU - Cotton, Antoinette
AU - Foy, Andrew J.
N1 - Funding Information:
Funding: None.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Background: As surgical techniques evolve and patient outcomes improve over time, a renewed analysis of the cardiac risk of noncardiac surgeries is needed. The goal of this study was to investigate and categorize the cardiac risk of elective noncardiac surgeries. Methods: This was a cohort study of surgical data and outcomes from the 2018 National Surgical Quality Improvement Program Participant Use Data File; 807,413 cases were analyzed after excluding non-elective, emergent, and cardiac surgeries. Postoperative major adverse cardiac events (MACE) were defined as 30-day all-cause mortality, myocardial infarction, or cardiac arrest. According to their 95% confidence intervals (CI) for postoperative MACE, surgeries were categorized as low risk (95% CI <1%), intermediate risk (95% CI above and below 1%), or elevated risk (95% CI ≥1%). Multivariable logistic regression analyses were performed to determine differences in the odds for postoperative MACE for the intermediate- and elevated-risk categories relative to the low-risk category while controlling for several risk factors of prognostic importance. Results: Postoperative MACE occurred in 4047/807,413 cases (0.50%), including in 1708/667,735 (0.26%) of the low-risk category, in 516/53,499 (0.96%) of the intermediate-risk category, and in 1823/86,179 (2.12%) of the elevated-risk category. The elevated-risk category accounted for 10.7% of total procedures and 45.1% of total postoperative MACE. Compared with the low-risk category, the multivariable adjusted risk of postoperative MACE was increased in the intermediate-risk category (adjusted odds ratio 2.35; 95% CI, 2.12-2.62) and the elevated-risk category (adjusted odds ratio 3.15; 95% CI, 2.92-3.39). Conclusion:: Categorization of noncardiac surgeries according to cardiac risk may help to identify populations who are most likely to benefit from preoperative cardiac evaluation when indicated.
AB - Background: As surgical techniques evolve and patient outcomes improve over time, a renewed analysis of the cardiac risk of noncardiac surgeries is needed. The goal of this study was to investigate and categorize the cardiac risk of elective noncardiac surgeries. Methods: This was a cohort study of surgical data and outcomes from the 2018 National Surgical Quality Improvement Program Participant Use Data File; 807,413 cases were analyzed after excluding non-elective, emergent, and cardiac surgeries. Postoperative major adverse cardiac events (MACE) were defined as 30-day all-cause mortality, myocardial infarction, or cardiac arrest. According to their 95% confidence intervals (CI) for postoperative MACE, surgeries were categorized as low risk (95% CI <1%), intermediate risk (95% CI above and below 1%), or elevated risk (95% CI ≥1%). Multivariable logistic regression analyses were performed to determine differences in the odds for postoperative MACE for the intermediate- and elevated-risk categories relative to the low-risk category while controlling for several risk factors of prognostic importance. Results: Postoperative MACE occurred in 4047/807,413 cases (0.50%), including in 1708/667,735 (0.26%) of the low-risk category, in 516/53,499 (0.96%) of the intermediate-risk category, and in 1823/86,179 (2.12%) of the elevated-risk category. The elevated-risk category accounted for 10.7% of total procedures and 45.1% of total postoperative MACE. Compared with the low-risk category, the multivariable adjusted risk of postoperative MACE was increased in the intermediate-risk category (adjusted odds ratio 2.35; 95% CI, 2.12-2.62) and the elevated-risk category (adjusted odds ratio 3.15; 95% CI, 2.92-3.39). Conclusion:: Categorization of noncardiac surgeries according to cardiac risk may help to identify populations who are most likely to benefit from preoperative cardiac evaluation when indicated.
UR - http://www.scopus.com/inward/record.url?scp=85115134002&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115134002&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2021.07.016
DO - 10.1016/j.amjmed.2021.07.016
M3 - Article
C2 - 34411519
AN - SCOPUS:85115134002
VL - 134
SP - 1499
EP - 1505
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 12
ER -