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Titolo:
Adverse cardiac events after surgery - Assessing risk in a veteran population
Autore:
Kumar, R; McKinney, WP; Raj, G; Heudebert, GR; Heller, HJ; Koetting, M; McIntire, DD;
Indirizzi:
UT, SW Med Sch, Vet Affairs Med Ctr, Dept Internal Med,Sect Gen Internal Med, Dallas, TX USA UT Dallas TX USA Dept Internal Med,Sect Gen Internal Med, Dallas, TX USA UT, SW Med Sch, Acad Comp Serv, Dallas, TX USA UT Dallas TX USAUT, SW Med Sch, Acad Comp Serv, Dallas, TX USA
Titolo Testata:
JOURNAL OF GENERAL INTERNAL MEDICINE
fascicolo: 8, volume: 16, anno: 2001,
pagine: 507 - 518
SICI:
0884-8734(200108)16:8<507:ACEAS->2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERIOPERATIVE MYOCARDIAL-INFARCTION; MAJOR VASCULAR-SURGERY; NONCARDIAC SURGERY; LOGISTIC-REGRESSION; TROPONIN-I; ANESTHESIA; MORTALITY; INDEX; REINFARCTION; VALIDATION;
Keywords:
cardiac risk; noncardiac surgery; risk index; risk factors; heart disease;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Kumar, R Edward Hines Jr Vet Adm Hosp, POB 5000, Hines, IL 60141 USA Edward Hines Jr Vet Adm Hosp POB 5000 Hines IL USA 60141 0141 USA
Citazione:
R. Kumar et al., "Adverse cardiac events after surgery - Assessing risk in a veteran population", J GEN INT M, 16(8), 2001, pp. 507-518

Abstract

OBJECTIVE: To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans. DESIGN. Prospective cohort study. SETTING: A large urban veterans affairs hospital. PARTICIPANTS: One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures. MEASUREMENTS: Patients were assessed preoperatively for important clinicalvariables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina. MAIN RESULTS: Severe and serious complications were seen in 24% and 32% ofaortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction <6months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction >6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% Cl, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model. CONCLUSIONS: Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of noncardiac surgery in veterans. Inclusion of the operative procedure significantly improves the predictive ability of the risk model. Overall cardiac complication rates (pretest probabilities) are established for these patients. A simple nomogram is presented for calculation of post-test probabilities by incorporating the operative procedure.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 31/03/20 alle ore 16:26:54