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Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery
- Source :
- Anesthesiology. 133:96-108
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Compared to other perioperative complications, failure to rescue (i.e., death after suffering a complication) is highest after perioperative myocardial infarction (a myocardial infarction that occurs intraoperatively or within 30 days after surgery). The purpose of this study was to identify patient and surgical risk factors for failure to rescue in patients who have had a perioperative myocardial infarction. Methods Individuals who experienced a perioperative myocardial infarction after noncardiac surgery between 2012 and 2016 were identified from the American College of Surgeons (Chicago, Illinois) National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue. Subgroup and sensitivity analyses evaluated the robustness of primary findings. Results The authors identified 1,307,884 individuals who had intermediate to high-risk noncardiac surgery. A total of 8,923 (0.68%) individuals had a perioperative myocardial infarction, of which 1,726 (19.3%) experienced failure to rescue. Strongest associations (adjusted odds ratio greater than 1.5) were age 85 yr or older (2.52 [95% CI, 2.05 to 3.09] vs. age younger than 65 yr), underweight body mass index (1.53 [95% CI, 1.17 to 2.01] vs. normal body mass index), American Society of Anesthesiologists class IV (1.76 [95% CI, 1.33 to 2.31] vs. class I or II) and class V (3.48 [95% CI, 2.20 to 5.48] vs. class I or II), and presence of: ascites (1.81 [95% CI, 1.15 to 2.87]), disseminated cancer (1.54 [95% CI, 1.18 to 2.00]), systemic inflammatory response syndrome (1.55 [95% CI, 1.26 to 1.90]), sepsis (1.75 [95% CI, 1.39 to 2.20]), septic shock (1.79 [95% CI, 1.34 to 2.37]), and dyspnea at rest (1.94 [95% CI, 1.32 to 2.86]). Patients who had emergency surgery, high-risk procedures, and postoperative complications were at higher risk of failure to rescue. Conclusions Routinely identified patient and surgical factors predict risk of failure to rescue after perioperative myocardial infarction. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
- Subjects :
- medicine.medical_specialty
business.industry
Septic shock
Odds ratio
Perioperative
030204 cardiovascular system & hematology
medicine.disease
Systemic inflammatory response syndrome
03 medical and health sciences
0302 clinical medicine
Anesthesiology and Pain Medicine
Internal medicine
medicine
030212 general & internal medicine
Myocardial infarction
Complication
business
Body mass index
Cohort study
Subjects
Details
- ISSN :
- 15281175 and 00033022
- Volume :
- 133
- Database :
- OpenAIRE
- Journal :
- Anesthesiology
- Accession number :
- edsair.doi...........03e53ba75448fd4a88c654e4ddff304e