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Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

Authors :
Ali A. Nasrallah
Habib A. Dakik
Nassib F. Abou Heidar
Jad A. Najdi
Oussama G. Nasrallah
Mazen Mansour
Hani Tamim
Albert El Hajj
Source :
Therapeutic Advances in Urology, Vol 14 (2022)
Publication Year :
2022
Publisher :
SAGE Publishing, 2022.

Abstract

Introduction: Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index. Methods: The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index. Results: In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A 4 CH model utilized six variables: A ge ⩾75 years, A SA class >2, A nemia, surgical A pproach, C reatinine >1.5, and history of H eart disease. Index ROC analysis provided a C-statistic of 0.81, calibration R 2 was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively. Conclusion: This study proposes a novel procedure-specific cardiovascular risk index. The PN-A 4 CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.

Details

Language :
English
ISSN :
17562880 and 17562872
Volume :
14
Database :
Directory of Open Access Journals
Journal :
Therapeutic Advances in Urology
Publication Type :
Academic Journal
Accession number :
edsdoj.133e8e5260ea4275b6bfa0d8feb7e2db
Document Type :
article
Full Text :
https://doi.org/10.1177/17562872221084847