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1. Perioperative troponin surveillance in major noncardiac surgery: a narrative review

Author

Chew, Michelle, Saugel, Bernd, and Lurati-Buse, Giovanna

Subjects
Anestesi och intensivvård, Anesthesiology and Pain Medicine, Anesthesiology and Intensive Care, biomarker, cardiac troponins, MINS, myocardial injury, noncardiac surgery, perioperative outcome
Abstract

Myocardial injury is now an acknowledged complication in patients undergoing noncardiac surgery. Heterogeneity in the definitions of myocardial injury contributes to difficulty in evaluating the value of cardiac troponins (cTns) measurement in perioperative care. Pre-, post-, and peri-operatively increased cTns are encompassed by the umbrella term myocardial injury and are likely to reflect different pathophysiological mechanisms. Increased cTns are independently associated with cardiovascular and non-cardiovascular complications, poor short-term and long-term cardiovascular outcomes, and increased mortality. Preoperative measurement of cTns aids preoperative risk stratification beyond the Revised Cardiac Risk Index. Systematic measurement detects acute perioperative increases and allows early identification of acute myocardial injury. Common definitions and standards for reporting are a prerequisite for designing impactful future trials and perioperative management strategies. Funding Agencies|Swedish Research Council, Sweden [2019-02833]; Linkoping University-Region Ostergotland, ALF, Sweden [687681, 792291]

Published
2023

2. Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis

Author

M’Pembele, René, Roth, Sebastian, Metzger, Aljoscha, Nucaro, Anthony, Stroda, Alexandra, Polzin, Amin, Hollmann, Markus W., Lurati Buse, Giovanna, Huhn, Ragnar, Anesthesiology, ACS - Heart failure & arrhythmias, APH - Quality of Care, APH - Global Health, and ACS - Microcirculation

Subjects
Anticoagulation, Mechanical circulatory support, Bleeding, Thrombosis, Hematology, Bivalirudin, Argatroban
Abstract

BackgroundThe number of patients treated with extracorporeal membrane oxygenation (ECMO) devices is increasing. Anticoagulation therapy is crucial to prevent thrombosis during ECMO therapy. Predominantly, heparin has been used as primary anticoagulant but direct thrombin inhibitors (DTI) have been established as alternatives. The aim of this systematic review and meta-analysis was to evaluate clinical outcomes in patients treated with heparin compared to different DTI during ECMO.MethodsA systematic search was conducted. Full scientific articles were sought for inclusion if heparin anticoagulation was compared to DTI (argatroban/bivalirudin) in ECMO patients. Risk of bias was assessed by Newcastle Ottawa scale. Primary endpoint was in-hospital mortality. Bleeding events, thrombotic events, hours of ECMO support, days of hospital stay, percentage of time within therapeutic range and time to therapeutic range were extracted from full texts as secondary endpoints. Results were presented as Forrest-plots. GRADE was used for confidence assessment in outcomes.ResultsSystematic search identified 4.385 records, thereof 18 retrospective studies for a total of 1942 patients, complied with the predefined eligibility criteria:15 studies investigated bivalirudin and 3 studies investigated argatroban versus heparin. Risk of bias was high for most studies. In-hospital mortality, major bleeding events and pump-related thrombosis were less frequent in DTI group as compared to heparin [mortality—OR 0.69, 95% CI 0.54–0.86; major bleeding—OR 0.48, 95% CI 0.29–0.81; pump thrombosis—OR 0.55, 95% CI 0.40–0.76]. Additionally, percentage of time within therapeutic range was higher for DTI [SMD 0.54, 95% CI 0.14–0.94]. GRADE approach revealed a very low level of certainty for each outcome.ConclusionIn this meta-analysis, DTI and especially bivalirudin showed beneficial effects on clinical outcomes in ECMO patients as compared to heparin.However, due to the lack of randomized trials, certainty of evidence is low.Trial RegistrationThis systematic review and meta-analysis was prospectively registered at PROSPERO data base (reference numberCRD42021237252).Graphical Abstract

Published
2022

4. Additional file 1 of Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis

Author

M’Pembele, René, Roth, Sebastian, Metzger, Aljoscha, Nucaro, Anthony, Stroda, Alexandra, Polzin, Amin, Hollmann, Markus W., Lurati Buse, Giovanna, and Huhn, Ragnar

Abstract

Additional file 1: Figure S1. Mortality analysisfor adult and pediatric patients. FigureS2. Mortality analysis for risk of bias. Figure S3. Major bleeding events for adult and pediatric patients. Figure S4. Percentage of time withintherapeutic range. Figure S5. lengthof hospital stays. Figure S6. Timeto reach anticoagulation goal. Figure S7.Funnel plots.

Published
2022
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6. Cardiovascular imaging following perioperative myocardial infarction/injury

Author

Arslani, Ketina, Gualandro, Danielle M., Puelacher, Christian, Lurati Buse, Giovanna, Lampart, Andreas, Bolliger, Daniel, Schulthess, David, Glarner, Noemi, Hidvegi, Reka, Kindler, Christoph, Blum, Steffen, Cardozo, Francisco A. M., Caramelli, Bruno, Gürke, Lorenz, Wolff, Thomas, Mujagic, Edin, Schaeren, Stefan, Rikli, Daniel, Campos, Carlos A., Fahrni, Gregor, Kaufmann, Beat A., Haaf, Philip, Zellweger, Michael J., Kaiser, Christoph, Osswald, Stefan, Steiner, Luzius A., Mueller, Christian, and Basel-PMI Investigators

Subjects
Multidisciplinary, Echocardiography, Risk Factors, Myocardial Infarction, Humans, Prospective Studies, Coronary Angiography
Abstract

Patients developing perioperative myocardial infarction/injury (PMI) have a high mortality. PMI work-up and therapy remain poorly defined. This prospective multicenter study included high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program. The frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction (T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/cardiologist, who determined selection/timing of cardiovascular imaging. T1M1 was considered with the presence of a new wall motion abnormality within 30 days in transthoracic echocardiography (TTE), a new scar or ischemia within 90 days in myocardial perfusion imaging (MPI), and Ambrose-Type II or complex lesions within 7 days of PMI in coronary angiography (CA). In patients with PMI, 21% (268/1269) underwent at least one cardiac imaging modality. TTE was used in 13% (163/1269), MPI in 3% (37/1269), and CA in 5% (68/1269). Cardiology consultation was associated with higher use of cardiovascular imaging (27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and 63% of CA. Most patients with PMI did not undergo any cardiovascular imaging within their PMI work-up. If performed, MPI and CA showed high yield for signs indicative of T1MI.Trial registration:https://clinicaltrials.gov/ct2/show/NCT02573532.

Published
2022
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7. Peri-interventional outcome study in the elderly in Europe : A 30-day prospective cohort study

Author

Kowark, Ana, Rossaint, Rolf, Rückbeil, Marcia V., Hilgers, Ralf-Dieter, Bilotta, Federico, Bollheimer, Leo C., Buhre, Wolfgang, Guenther, Ulf, Hoeft, Andreas, Lee, Peter, Matot, Idit, Rex, Steffen, Steinmetz, Jacob, Tournoy, Jos, Alanoglu, Zekeriyya, Berger, Marc M., Falières, Xavier, Goettel, Nicolai, Kartalov, Andrijan, Katsanoulas, Konstantinos, Kenig, Jakub, Khoronenko, Victoria, Lundstrøm, Lars H., Macharadze, Tamar, Milenovic, Miodrag, Molliex, Serge, Órfão, Rosário, Soro, Marina, Stefan, Mihai, Sungur, Zerrin, Szakmany, Tamas, Baños, Victoria, Rodriguez, Mireia, Martinez, Selene, Saller, Thomas, Schäfer, Simon T., Clermond, Edouard, Martin, Charlotte, Le Moal, Charlene, Staikowsky, Frederik, Delannoy, Bertand, Desebbe, Olivier, Missant, Carlo, Desmet, Matthias, Gillmann, Hans-Joerg, Stueber, Thomas, Dalsø, Sille M., Vester-Andersen, Morten, Ranft, Andreas, Schneider, Gerhard, Huygens, Christel, Meeusen, Roselien, Cruz, Patricia, Fernández, Carmen, Otto, Mareike, Giltaire, Agathe, Hofmann, Pascal, Gurlit, Simone, Fernández, Alejandro Romero, Castelli, Federica, Ntouba, Alexandre, Lanoiselée, Julien, Schulz, Regina, Opperer, Mathias, Van Waesberghe, Julia, Ziemann, Sebastian, Refaeli-Awin, Einat, Bengisun, Zuleyha Kazak, Buchman, Immanuel, Yahav-Shafir, Dana, Dimakopoulou, Antonia, Le Guen, Morgan, Rodríguez-Pérez, Aurelio, Beran, Maud, Bonnal, Aurelien, Garot, Matthias, Maupain, Olivier, Michel, Denis, Fernandes, Sofia, Sanabra, Maria, Mangoubi, Eitan, Boselli, Emmanuel, Switzer, Timothy, García-Sánchez, Jose I., Boisson, Matthieu, Stamoulis, Konstantinos, García, María Merino, Wulf, Hinnerk, Gouraud, David, Lebrun, Christophe, Lasocki, Sigismond, Steiner, Luzius A., Bergmann, Lars, Baenziger, Bertram, Karpetas, Georgios, Meco, Basak C., Hızal, Ayşe, Hernández, Rosa Méndez, Smit-Fun, Valerie, Charco, Pedro, Nickel, Frank, Grau Torradeflot, Laura, Coburn, Mark, Berger, Marc, Farcher, Helmut, Adriaensens, Ine, Saldien, Vera, Berghmans, Johan, Van Hove, Sofie, Eerdekens, Gert-Jan, Mesotten, Dieter, Timmers, Maxim, Vandermeulen, Elly, De Bruyne, Ann, De Hert, Stefan, De Ruyter, Hendrik, Van Belleghem, Vincent, Boscart, Isabelle, De Corte, Wouter, Carlier, Stefaan, Castelain, Charlotte, Demeyer, Caroline, Vandenbossche, Carl, Detienne, Hans, Devroe, Sarah, Dewinter, Geertrui, Hoogma, Danny, Van de Velde, Marc, Poels, Stéphanie, Soetens, Filiep, Fenger-Eriksen, Christian, Draegert, Christina, Santos, Sofia Gaspar, Soelling, Christine, Andersen, Gertrud, Haderslev, Pernille, Rasmussen, Vibe M., Sommer, Tine G., Kirkegaard, Johan, Olesen, Christian M., Paramanathan, Sansu, Jensen, Lisbet Tokkesdal, Knudsen, Halfdan H., Schmidt, Jens C., Stehen, Nick P., Dupont, Hervé, Herbinet, Clément, Lorne, Emmanuel, Mahjoub, Yazine, Fritsch, Marine, Garcia, Manuela, Petit Phan, Jonathan, Lieutaud, Thomas, Bonneric, Laura, Gaillet, Maxime, des Déserts, Marc Danguy, Montelescaut, Etienne, Lamblin, Antoine, Muller, Violaine, Lagrange, Celine, Robert, Alain, Lebas, Benoit, Lebuffe, Gilles, Beuvelot, Johanne, Dejour, David, Deligne, Emmanuel, Gignoux, Benoit, Guillaud, Olivier, Nloga, Joseph, Prunier-Bossion, Florence, Sibellas, Franck, Abraham, Paul, Bidon, Cyril, Rimmele, Thomas, Bruge-Ansel, Marie-Hélène, Friggeri, Arnaud, Lukaszewicz, Anne-Claire, Dziadzko, Mikhail, Leone, Marc, Meresse, Zoe, Pastene, Bruno, Odin, Isabelle, Bouic, Nicolas, Trinh Duc, Pierre, Pillant, Thomas, Riboulet, Fabien, Degoul, Samuel, Saumier, Nicolas, Wasilewski, Marion, Asehnoune, Karim, Roquilly, Antoine, Glasman, Pauline, Puybasset, Louis, Garnier, Fanny, Verdonk, Franck, Samama, Charles M., Towa, Line, Blet, Alice, Barrau, Stéphanie, Debaene, Bertrand, Frasca, Denis, Imzi, Nadia, Delvaux, Bernard, Huynh, Davy, Mercadal, Luc, Zanoun, Nabil, de Baene, Armelle, Boulay-Maninovsky, Catherine, Fernandes, Olivier, Gomis, Philippe, Malinovsky, Jean-Marc, Romain, François-Xavier, Calmelet, Astrid, Dupont, Ségolène, Millet, Sophie, Simonneau, Frédéric, Charret, Francoise, Couturier, Charlène, Lornage, Estelle, Mallard, Jeremy, Milati, Ryan, Passot, Sylvie, Vallier, Sylvain, Agavriloaia, Mihaela L., Badoux, Quentin, Lewandowski, Mehdi, Mermet, Yanis, Kiskira, Olga, Adjavon, Sherifa, Dumans, Virginie, Josserand, Julien, Ma, Sabrina, Castanera, Jeremy, Massiera, Benjamin, Petua, Philippe, Bounes-Vardon, Fanny, Bosc, Gaëlle, Bosch, Laëtitia, Ferre, Fabrice, Labaste, François, Menut, Rémi, Minville, Vincent, Srairi, Mohamed, Tarasi, Maria, Varin, Florent, Grüßer, Linda, Nowak, Hartmuth, Oprea, Günther, Rump, Katharina, Unterberg, Matthias, Vogelsang, Heike, Klutzny, Mitja, Neumann, Claudia, Soehle, Martin, Wittmann, Maria, Scharffenberg, Martin, Wittenstein, Jakob, Hinterberg, Jonas, Kienbaum, Peter, Lurati-Buse, Giovanna, Schäfer, Maximilian, Lindau, Simone, Meybohm, Patrick, Piekarski, Florian, Kaufhold, Theresa A., Koppert, Wolfgang, Leffler, Andreas, Reiffen, Hans-Peter, Rudolph, Diana, Starke, Henning, Bischoff, Petra, Haberecht, Heinz, Plehn, Heiko, Bauer, Michael, Kortgen, Andreas, Sponholz, Christoph, Krüger, Uwe, Müller-Esch, Sabine, Rempf, Christian, Schmidt, Christian, Schumacher, Dunja, Blazek, Juliane, Büttner, Christin, Leibeling, Andrea, Rüsch, Dirk, Burow, Karsten, El-Hilali, Eugen A., Greke, Christian, Großmann, Paul, Kluth, Mario, Dridi, Sofiane, Popovska, Ivana, Brenes, Andrés, Feddersen, Pia, Gerstmeyer, Dominik, Fthenakis, Philippe, Miketta, Dirk, von Dossow, Vera, Groene, Philipp, Höchter, Dominik, Hofmann-Kiefer, Klaus, Kammerer, Tobias, Kamrath, Malte, Schaefer, Simon T., Tomasi, Roland, Wiedemann, Tobias, Zeuzem-Lampert, Catharina, Zwissler, Bernhard, Braune, Stephan, Brune, Mona, Hemping-Bovenkerk, André, Möllmann, Michael, Santamaria, Mario, Schirwitz, Leonie M., Meersch, Melanie, Zarbock, Alexander, Decker, Stefanie, Drexler, Berthold, Hipp, Silvia, Müller, Markus, Roth, Judith, Seiß, Miriam, Adam, Christian, Schwartges, Ingo, Kranke, Peter, Chloropoulou, Pelagia, Andreeva, Antonia, Douma, Amalia, Gregoriadou, Iphigeneia, Koutsouli, Evelina, Mendrinou, Konstantina, Mavrommati, Eirini, Stathopoulos, Anastasios, Batistaki, Chrysanthi, Matsota, Paraskevi, Kalopita, Konstantina, Skandalou, Vasiliki, Balanika, Marina, Papathanakos, Georgios, Tzimas, Petros, Ketikidou, Evgenia, Vachlioti, Anastasia, Kiamiloglou, Bioulent, Nikouli, Evangelia, Arnaoutoglou, Eleni, Kolonia, Konstantina, Laou, Eleni, Vlachakis, Epaminondas, Lianou, Ioanna, Spyraki, Maria, Tatani, Irini, Panagiotou, Eleni, Samara, Evangelia, Kolesnikova, Anna, Sifaki, Freideriki, Zarzava, Eirini, Bampzelis, Athanasios, Georgopoulou, Eleni, Christidou, Eleni, Tsaousi, Georgia, Nastou, Maria, Ioannidis, Orestis, Dolzenko, Eugene, Geleve, Georgia, Logotheti, Eleni, Yfantidis, Fotios, Rajamanickam, Senbagam, Ramaswamy, Shanmuga, Das Punshi, Gurmukh, Srinivasan, Karthikeyan, Gilmartin, Michael, Morris, Osmond, Gozal, Yaacov, Merissat, Amar, Peled, Reut, Willner, Dafna, Chariski, Hila A., Eidelman, Leonid A., Livne, Michal Y., Berkenstadt, Haim, Orlcin, Dina, Aharonov, Rita, Cattan, Anat, Felman, Lior, Steinberg, Yohai, Zabeeda, Wisam, Kuzmanovska, Biljana, Naumovski, Filip, Toleska, Marija, Sivevski, Atanas, Andriessen, Anouk, Kortekaas, Minke, Van Gorp, Roos, de Korte-de Boer, Dianne, Theunissen, Maurice, Droger, Mirjam, van den Enden, Toine, Koopman, Seppe, Marsman, Marije, van Schaik, Eva, Azenha, Marta, Lanzaro, Camile, Borrego, Andreia, Branquinho, Pedro, Laires, Miguel, de Noronha, Denise, Ferraz, Inês, Pires, Ana, Silva, Joana, Corneci, Dan, Oprea, Oana, Zahiu, Stefan-Vladimir, Tomescu, Dana R., Grintescu, Ioana M., Filipescu, Daniela, Stefanescu, Elena, Vazenin, Andrey, Baskakov, Danil, Tipisev, Dmitry, Kozlova, Ksenia, Marinkovic, Olivera, Sekulic, Ana, Rajkovic, Marija, Djukanovic, Marija, Nikolic, Jovanka, Sreckovic, Svetlana, Stojanovic, Marina, Ladjevic, Nebojsa, Jovicic, Jelena, Unic-Stojanovic, Dragana, Stosic, Biljana, Bulasevic, Aleksandra, Espinosa-Moreno, Alma M., Martín-Vaquerizo, Beatriz, Morandeira-Rivas, Clara, Zamudio, Diana, Guadalupe, Nerea, Herranz, Gracia, Baute, Javier, Madrona, Vanesa, de Jose, Roser, Miralles, Jordi, Merten, Alfred, Muñoz, Rolando, Delgado, Anabel, Moral, Victoria, Blesa, Aleix Carmona, Espejo, Sara, Grau Torredeflot, Laura, Pujol, Pere Serra, Alvira Uribe, Maria J., Perez, Astrid Alvarez, Brunetto, Espedito, Aguirre, Jorge Gonzalez, Villar, Adriana Herivas, Rojas, Guido Munoz, Montero, Natalia, González, Víctor Baladrón, Becerra-Bolaños, Ángel, Santana-Ortega, Luis, Suárez-Romero, Vanessa, Torres-Machí, María L., Ferrero de Paz, Javier, Marcos-Vidal, Jose M., Garcia, Ana Martín, Diaz, Consuelo Rego, Santiago, Ana Crespo, Laso, Lourdes Ferreira, Solores, Felix Lobato, Burgos, Alba, Calvo, Alberto, Fernández, Ignacio, Garutti, Ignacio, Higuero, Fernando, Martinez, David, Piñeiro, Patricia, Carazo, Sonia Expósito, Rodríguez, Mar Orts, Rueda, Fernando Ramasco, Abad-Motos, Ane, Ripollés-Melchor, Javier, López, Carmen Pastor, Perez-Palao, Sara, Sancho-Iñigo, Laura, Segura, Nasara, Utrera, Esther, Albinarrate, Ania, Fondarella, Ana M., Gallego-Ligorit, Lucia, Torrijos, Luisa Lacosta, Bandschapp, Oliver, Blum, Andrea A., Seeberger, Esther, Thomann, Alessandra E., Frei, Seraina, Hoehn, Susan, Capaldo, Giuliana, Christ, Daniel, Doerig, Ramon, Hodel, Daniel, Weiss, Andreas, Witt, Lukas, Schumacher, Philippe, Siebing, Dirk A., Akbuz, Seyma Orcan, Kazbek, Baturay K., Koksoy, Ulku C., Terzi, Engin Z., Yilmaz, Hakan, Alkis, Neslihan, Turhan, Sanem Cakar, Hajiyeva, Konul, Guclu, Cigdem Yildirim, Ergil, Jülide, Ceran, Emine Unal, Ozcelik, Menekse, Bülent, Atik, Gökhan, Kilinc, Saracoglu, Kemal T., Kir, Bunyamin, Koltka, Kemalettin, Sivrikoz, Nükhet, Dincer, Pelin Corman, Canbolat, Nur, Kudsioglu, Turkan, Aydin, Gaye, Mucuoglu, Ceren Aygün, Inal, Duriye G., Kucukguclu, Semih, Egilmez, Ayse I., Kozanhan, Betul, Yildiz, Munise, Pinar, Hüseyin U., Erdivanlı, Başar, Karagöz, Emre, Kazdal, Hızır, Özdemir, Abdullah, Tas Tuna, Ayca, Gulgun, Gamze, and Oleg, Dolya

Abstract

European journal of anaesthesiology : EJA 39(3), 198-209 (2022). doi:10.1097/EJA.0000000000001639, Published by Lippincott Williams & Wilkins, Philadelphia, Pa.

Published
2022
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8. Fibrinogen–Albumin-Ratio is an independent predictor of thromboembolic complications in patients undergoing VA-ECMO

Author

Roth, Sebastian, Jansen, Catrin, M’Pembele, René, Stroda, Alexandra, Boeken, Udo, Akhyari, Payam, Lichtenberg, Artur, Hollmann, Markus W., Huhn, Ragnar, Lurati Buse, Giovanna, Aubin, Hug, Anesthesiology, ACS - Heart failure & arrhythmias, APH - Quality of Care, APH - Global Health, and ACS - Microcirculation

Subjects
Male, Science, education, Fibrinogen, hemic and immune systems, Middle Aged, Predictive markers, Article, surgical procedures, operative, Extracorporeal Membrane Oxygenation, Albumins, Thromboembolism, Medicine, Humans, Female, tissues, Biomarkers, Cardiac device therapy, Aged, Retrospective Studies
Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients suffering from refractory cardiogenic shock. Thromboembolic complications (TeC) are common in VA-ECMO patients and are associated with increased morbidity and mortality. Valid markers to predict TeC in VA-ECMO patients are lacking. The present study investigated the predictive value of baseline Fibrinogen–Albumin-Ratio (FAR) for in-hospital TeC in patients undergoing VA-ECMO. This retrospective cohort study included patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany between 2011 and 2018. Main exposure was baseline FAR measured at initiation of VA-ECMO therapy. The primary endpoint was the in-hospital incidence of TeC. In total, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. Receiver operating characteristics (ROC) curve of FAR for in-hospital TeC revealed an area under the curve of 0.67 [95% confidence interval (CI) 0.61–0.74]. Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds-ratio of 3.72 [95% CI 2.26–6.14] for the association between FAR and TeC. Baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, FAR might contribute to the prediction of TeC in this cohort.

Published
2021

10. Adherence to the European Society of Cardiology/European Society of Anaesthesiology recommendations on preoperative cardiac testing and association with positive results and cardiac events: a cohort study

Author

Lurati Buse, Giovanna A. L., Puelacher, Christian, Gualandro, Danielle Menosi, Kilinc, Derya, Glarner, Noemi, Hidvegi, Reka, Bolliger, Daniel, Arslani, Ketina, Lampart, Andreas, Steiner, Luzius A., Kindler, Christoph, Wolff, Thomas, Mujagic, Edin, Guerke, Lorenz, Mueller, Christian, Incidence, and Outcome of Perioperative Myocardial Injury After Non-cardiac Sur

Published
2021
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11. Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Author

du Fay de Lavallaz, Jeanne, Puelacher, Christian, Lurati Buse, Giovanna, Bolliger, Daniel, Germanier, Dominic, Hidvegi, Reka, Walter, Joan Elias, Twerenbold, Raphael, Strebel, Ivo, Badertscher, Patrick, Sazgary, Lorraine, Lampart, Andreas, Espinola, Jaqueline, Kindler, Christoph, Hammerer-Lercher, Angelika, Thambipillai, Saranya, Guerke, Lorenz, Rentsch, Katharina, Buser, Andreas, Gualandro, Danielle, Jakob, Marcel, Mueller, Christian, and Basel-PMI Investigators

Subjects
Male, medicine.medical_specialty, Myocardial Infarction, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Troponin T, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Propensity Score, Aged, Morning, business.industry, Incidence, Incidence (epidemiology), Perioperative, Prognosis, medicine.disease, Circadian Rhythm, Cardiac surgery, C-Reactive Protein, Surgical Procedures, Operative, Anesthesia, Preoperative Period, Cohort, Propensity score matching, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Switzerland, Follow-Up Studies
Abstract

ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.

Published
2019
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12. The concept of peri-operative medicine to prevent major adverse events and improve outcome in surgical patients: A narrative review

Author

Bollen Pinto, Bernardo, Chew, Michelle, Lurati Buse, Giovanna, and Walder, Bernard

Subjects
Perioperative Care/methods, Postoperative Complications/etiology/prevention & control, Surgical Procedures, Treatment Outcome, ddc:617, Quality of Life, Humans, Patient Care Team/organization & administration, Operative/adverse effects, Patient-Centered Care/methods/organization & administration, Critical Pathways/organization & administration
Abstract

Peri-operative Medicine is the patient-centred and value-based multidisciplinary peri-operative care of surgical patients. Peri-operative stress, that is the collective response to stimuli occurring before, during and after surgery, is, together with pre-existing comorbidities, the pathophysiological basis of major adverse events. The ultimate goal of Peri-operative Medicine is to promote high quality recovery after surgery. Clinical scores and/or biomarkers should be used to identify patients at high risk of developing major adverse events throughout the peri-operative period. Allocation of high-risk patients to specific care pathways with peri-operative organ protection, close surveillance and specific early interventions is likely to improve patient-relevant outcomes, such as disability, health-related quality of life and mortality.

Published
2019

13. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

Author

Devereaux, P.J., Biccard, Bruce M., Sigamani, Alben, Xavier, Denis, Chan, Matthew T. V., Srinathan, Sadeesh K., Walsh, Michael, Abraham, Valsa, Pearse, Rupert, Wang, Y., Sessler, Daniel I., Kurz, Andrea, Szczeklik, Wojciech, Berwanger, Otavio, Villar, Juan Carlos, Malaga, German, Garg, Amit X., Chow, Clara K., Ackland, Gareth, Patel, Ameen, Kessler Borges, Flavia, Belley-Cote, Emilie P., Duceppe, Emmanuelle, Spence, Jessica, Tandon, Vikas, Williams, Colin, Sapsford, Robert J., Polanczyk, Carisi A., Tiboni, Maria, Alonso-Coello, Pablo, Faruqui, Atiya, Heels-Ansdell, Diane, Lamy, Andre, Whitlock, Richard, LeManach, Yannick, Roshanov, Pavel S., McGillion, Michael, Kavsak, Peter, McQueen, Matthew J., Thabane, Lehana, Rodseth, Reitze N., Lurati Buse, Giovanna A., Bhandari, Mohit, Garutti, Ignacia, Jacka, Michael J., Schunemann, Holger J., Cortes, Olga Lucia, Coriat, Pierre, Dvirnik, Nazari, Botto, Fernando, Pettit, Shirley, Jaffe, Allan S., Guyatt, Gordon H., and VISION Study Investigators

Subjects
Male, Myocardial Ischemia/mortality, Myocardial Infarction, Myocardial Ischemia, 030204 cardiovascular system & hematology, Risk Assessment, Preoperative care, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Troponin T, 030202 anesthesiology, medicine, Humans, Prospective Studies, Postoperative Period, Myocardial infarction, Prospective cohort study, Myocardial Infarction/mortality, Aged, Troponin T/blood, medicine.diagnostic_test, business.industry, Hazard ratio, General Medicine, Perioperative, Middle Aged, medicine.disease, purl.org/pe-repo/ocde/ford#3.02.00 [https], Editorial, Anesthesia, Female, Risk assessment, business, Electrocardiography
Abstract

IMPORTANCE Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). OBJECTIVE To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. EXPOSURES Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. MAIN OUTCOMES AND MEASURES A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. RESULTS Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT = 5 ng/L or hsTnT >= 65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. CONCLUSIONS AND RELEVANCE Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

Published
2017

14. Peri-interventional outcome study in the elderly in Europe A 30-day prospective cohort study

Author

Ana Sekulic, Selene Martinez Perez, Danny Feike Hoogma, GÖKHAN KILINÇ, Marc Danguy des Déserts, Evangelia Samara, AYSE HIZAL, Nicolai Goettel, Martin Scharffenberg, Sofia Fernandes, Jose Ignacio García-Sánchez, Tobias Kammerer, Marc Moritz Berger, Florian Piekarski, CEREN AYGÜN MUÇUOĞLU, PATRICIA PIÑEIRO OTERO, Angel Becerra, Aurelio Rodriguez-Perez, Ülkü Ceren Köksoy, Jakob Wittenstein, Lars Lundstrøm, Diana Zamudio Penko, Hans-Joerg Gillmann, Dianne De Korte-de Boer, Jose miguel Marcos-vidal, Sebastian Ziemann, Tournoy, Jos, Kowark, Ana, Rossaint, Rolf, Matot, Idit, Nickel, Frank, Grau Torradeflot, Laura, Coburn, Mark, Berger, Marc, Farcher, Helmut, Opperer, Mathias, Adriaensens, Ine, Saldien, Vera, Berghmans, Johan, Van Hove, Sofie, Rex, Steffen, Beran, Maud, Eerdekens, Gert-Jan, Mesotten, Dieter, Timmers, Maxim, Vandermeulen, Elly, De Bruyne, Ann, De Hert, Stefan, De Ruyter, Hendrik, Van Belleghem, Vincent, Boscart, Isabelle, Steinmetz, Jacob, De Corte, Wouter, Desmet, Matthias, Missant, Carlo, Carlier, Stefaan, Castelain, Charlotte, Demeyer, Caroline, Vandenbossche, Carl, Detienne, Hans, Devroe, Sarah, Dewinter, Geertrui, Hoogma, Danny, Huygens, Christel, Meeusen, Roselien, Van de Velde, Marc, Lebrun, Christophe, Poels, Stéphanie, Soetens, Filiep, Fenger-Eriksen, Christian, Alanoglu, Zekeriyya, Draegert, Christina, Santos, Sofia Gaspar, Soelling, Christine, Andersen, Gertrud, Dalsø, Sille M., Haderslev, Pernille, Rasmussen, Vibe M., Vester-Andersen, Morten, Sommer, Tine G., Berger, Marc M., Kirkegaard, Johan, Lundstrøm, Lars H., Olesen, Christian M., Paramanathan, Sansu, Jensen, Lisbet Tokkesdal, Knudsen, Halfdan H., Schmidt, Jens C., Stehen, Nick P., Dupont, Hervé, Herbinet, Clément, Falières, Xavier, Lorne, Emmanuel, Mahjoub, Yazine, Ntouba, Alexandre, Fritsch, Marine, Garcia, Manuela, Lasocki, Sigismond, Petit Phan, Jonathan, Lieutaud, Thomas, Bonneric, Laura, Boselli, Emmanuel, Goettel, Nicolai, Gaillet, Maxime, des Déserts, Marc Danguy, Montelescaut, Etienne, Lamblin, Antoine, Muller, Violaine, Lagrange, Celine, Le Moal, Charlene, Robert, Alain, Staikowsky, Frederik, Lebas, Benoit, Kartalov, Andrijan, Lebuffe, Gilles, Garot, Matthias, Beuvelot, Johanne, Dejour, David, Deligne, Emmanuel, Desebbe, Olivier, Delannoy, Bertand, Gignoux, Benoit, Guillaud, Olivier, Nloga, Joseph, Katsanoulas, Konstantinos, Prunier-Bossion, Florence, Sibellas, Franck, Abraham, Paul, Bidon, Cyril, Rimmele, Thomas, Bruge-Ansel, Marie-Hélène, Friggeri, Arnaud, Lukaszewicz, Anne-Claire, Dziadzko, Mikhail, Leone, Marc, Rückbeil, Marcia V., Kenig, Jakub, Meresse, Zoe, Pastene, Bruno, Odin, Isabelle, Bonnal, Aurelien, Bouic, Nicolas, Trinh Duc, Pierre, Pillant, Thomas, Riboulet, Fabien, Degoul, Samuel, Saumier, Nicolas, Khoronenko, Victoria, Wasilewski, Marion, Asehnoune, Karim, Roquilly, Antoine, Glasman, Pauline, Puybasset, Louis, Garnier, Fanny, Verdonk, Franck, Samama, Charles M., Towa, Line, Blet, Alice, Barrau, Stéphanie, Boisson, Matthieu, Debaene, Bertrand, Frasca, Denis, Imzi, Nadia, Delvaux, Bernard, Huynh, Davy, Maupain, Olivier, Mercadal, Luc, Zanoun, Nabil, Macharadze, Tamar, de Baene, Armelle, Boulay-Maninovsky, Catherine, Fernandes, Olivier, Giltaire, Agathe, Gomis, Philippe, Malinovsky, Jean-Marc, Romain, François-Xavier, Calmelet, Astrid, Dupont, Ségolène, Gouraud, David, Milenovic, Miodrag, Millet, Sophie, Simonneau, Frédéric, Charret, Francoise, Couturier, Charlène, Lanoiselée, Julien, Lornage, Estelle, Mallard, Jeremy, Milati, Ryan, Passot, Sylvie, Vallier, Sylvain, Molliex, Serge, Agavriloaia, Mihaela L., Badoux, Quentin, Lewandowski, Mehdi, Mermet, Yanis, Michel, Denis, Kiskira, Olga, Adjavon, Sherifa, Dumans, Virginie, Le Guen, Morgan, Josserand, Julien, Órfão, Rosário, Ma, Sabrina, Castanera, Jeremy, Massiera, Benjamin, Petua, Philippe, Bounes-Vardon, Fanny, Bosc, Gaëlle, Bosch, Laëtitia, Clermond, Edouard, Ferre, Fabrice, Labaste, François, Soro, Marina, Martin, Charlotte, Menut, Rémi, Minville, Vincent, Srairi, Mohamed, Tarasi, Maria, Varin, Florent, Grüßer, Linda, Stefan, Mihai, Van Waesberghe, Julia, Ziemann, Sebastian, Bergmann, Lars, Nowak, Hartmuth, Oprea, Günther, Rump, Katharina, Unterberg, Matthias, Vogelsang, Heike, Klutzny, Mitja, Neumann, Claudia, Sungur, Zerrin, Soehle, Martin, Wittmann, Maria, Scharffenberg, Martin, Wittenstein, Jakob, Hinterberg, Jonas, Kienbaum, Peter, Lurati-Buse, Giovanna, Schäfer, Maximilian, Lindau, Simone, Hilgers, Ralf-Dieter, Szakmany, Tamas, Meybohm, Patrick, Gillmann, Hans-Joerg, Piekarski, Florian, Kaufhold, Theresa A., Koppert, Wolfgang, Leffler, Andreas, Reiffen, Hans-Peter, Rudolph, Diana, Starke, Henning, Stueber, Thomas, Baños, Victoria, Bischoff, Petra, Haberecht, Heinz, Plehn, Heiko, Bauer, Michael, Kortgen, Andreas, Sponholz, Christoph, Krüger, Uwe, Müller-Esch, Sabine, Otto, Mareike, Rempf, Christian, Rodriguez, Mireia, Schmidt, Christian, Schumacher, Dunja, Blazek, Juliane, Büttner, Christin, Leibeling, Andrea, Rüsch, Dirk, Wulf, Hinnerk, Burow, Karsten, El-Hilali, Eugen A., Greke, Christian, Martinez, Selene, Großmann, Paul, Kluth, Mario, Schulz, Regina, Dridi, Sofiane, Popovska, Ivana, Brenes, Andrés, Ranft, Andreas, Feddersen, Pia, Gerstmeyer, Dominik, Fthenakis, Philippe, Saller, Thomas, Schneider, Gerhard, Miketta, Dirk, von Dossow, Vera, Groene, Philipp, Höchter, Dominik, Hofmann-Kiefer, Klaus, Kammerer, Tobias, Kamrath, Malte, Schaefer, Simon T., Schäfer, Simon T., Tomasi, Roland, Wiedemann, Tobias, Zeuzem-Lampert, Catharina, Zwissler, Bernhard, Braune, Stephan, Brune, Mona, Gurlit, Simone, Hemping-Bovenkerk, André, Möllmann, Michael, Santamaria, Mario, Schirwitz, Leonie M., Meersch, Melanie, Zarbock, Alexander, Guenther, Ulf, Decker, Stefanie, Drexler, Berthold, Hipp, Silvia, Hofmann, Pascal, Müller, Markus, Roth, Judith, Seiß, Miriam, Adam, Christian, Schwartges, Ingo, Kranke, Peter, Chloropoulou, Pelagia, Andreeva, Antonia, Dimakopoulou, Antonia, Douma, Amalia, Gregoriadou, Iphigeneia, Koutsouli, Evelina, Mendrinou, Konstantina, Mavrommati, Eirini, Stathopoulos, Anastasios, Batistaki, Chrysanthi, Matsota, Paraskevi, Kalopita, Konstantina, Skandalou, Vasiliki, Balanika, Marina, Papathanakos, Georgios, Tzimas, Petros, Ketikidou, Evgenia, Vachlioti, Anastasia, Kiamiloglou, Bioulent, Nikouli, Evangelia, Arnaoutoglou, Eleni, Kolonia, Konstantina, Laou, Eleni, Stamoulis, Konstantinos, Vlachakis, Epaminondas, Bilotta, Federico, Karpetas, Georgios, Lianou, Ioanna, Spyraki, Maria, Tatani, Irini, Panagiotou, Eleni, Samara, Evangelia, Kolesnikova, Anna, Sifaki, Freideriki, Zarzava, Eirini, Bampzelis, Athanasios, Georgopoulou, Eleni, Christidou, Eleni, Tsaousi, Georgia, Nastou, Maria, Ioannidis, Orestis, Dolzenko, Eugene, Geleve, Georgia, Logotheti, Eleni, Yfantidis, Fotios, Lee, Peter, Rajamanickam, Senbagam, Ramaswamy, Shanmuga, Switzer, Timothy, Das Punshi, Gurmukh, Srinivasan, Karthikeyan, Gilmartin, Michael, Morris, Osmond, Buchman, Immanuel, Gozal, Yaacov, Merissat, Amar, Peled, Reut, Willner, Dafna, Chariski, Hila A., Eidelman, Leonid A., Livne, Michal Y., Mangoubi, Eitan, Berkenstadt, Haim, Orlcin, Dina, Yahav-Shafir, Dana, Aharonov, Rita, Cattan, Anat, Felman, Lior, Refaeli-Awin, Einat, Steinberg, Yohai, Zabeeda, Wisam, Kuzmanovska, Biljana, Naumovski, Filip, Toleska, Marija, Sivevski, Atanas, Andriessen, Anouk, Kortekaas, Minke, Buhre, Wolfgang, Van Gorp, Roos, de Korte-de Boer, Dianne, Smit-Fun, Valerie, Theunissen, Maurice, Droger, Mirjam, van den Enden, Toine, Koopman, Seppe, Marsman, Marije, van Schaik, Eva, Azenha, Marta, Lanzaro, Camile, Borrego, Andreia, Branquinho, Pedro, Fernandes, Sofia, Laires, Miguel, de Noronha, Denise, Ferraz, Inês, Pires, Ana, Silva, Joana, Corneci, Dan, Oprea, Oana, Zahiu, Stefan-Vladimir, Tomescu, Dana R., Grintescu, Ioana M., Filipescu, Daniela, Stefanescu, Elena, Vazenin, Andrey, Baskakov, Danil, Tipisev, Dmitry, Kozlova, Ksenia, Marinkovic, Olivera, Sekulic, Ana, Rajkovic, Marija, Djukanovic, Marija, Nikolic, Jovanka, Sreckovic, Svetlana, Stojanovic, Marina, Ladjevic, Nebojsa, Jovicic, Jelena, Unic-Stojanovic, Dragana, Bollheimer, Leo C., Stosic, Biljana, Bulasevic, Aleksandra, Espinosa-Moreno, Alma M., García-Sánchez, Jose I., Martín-Vaquerizo, Beatriz, Morandeira-Rivas, Clara, Zamudio, Diana, Guadalupe, Nerea, Herranz, Gracia, Baute, Javier, Madrona, Vanesa, de Jose, Roser, Miralles, Jordi, Merten, Alfred, Muñoz, Rolando, Delgado, Anabel, Cruz, Patricia, Moral, Victoria, Blesa, Aleix Carmona, Espejo, Sara, Grau Torredeflot, Laura, Fernández, Alejandro Romero, Sanabra, Maria, Pujol, Pere Serra, Alvira Uribe, Maria J., Perez, Astrid Alvarez, Brunetto, Espedito, Fernández, Carmen, Castelli, Federica, Aguirre, Jorge Gonzalez, Villar, Adriana Herivas, Rojas, Guido Munoz, Montero, Natalia, González, Víctor Baladrón, Becerra-Bolaños, Ángel, Rodríguez-Pérez, Aurelio, Santana-Ortega, Luis, Suárez-Romero, Vanessa, Torres-Machí, María L., Ferrero de Paz, Javier, Marcos-Vidal, Jose M., Garcia, Ana Martín, García, María Merino, Diaz, Consuelo Rego, Santiago, Ana Crespo, Laso, Lourdes Ferreira, Solores, Felix Lobato, Burgos, Alba, Calvo, Alberto, Fernández, Ignacio, Garutti, Ignacio, Higuero, Fernando, Martinez, David, Piñeiro, Patricia, Carazo, Sonia Expósito, Hernández, Rosa Méndez, Rodríguez, Mar Orts, Rueda, Fernando Ramasco, Abad-Motos, Ane, Ripollés-Melchor, Javier, López, Carmen Pastor, Charco, Pedro, Perez-Palao, Sara, Sancho-Iñigo, Laura, Segura, Nasara, Utrera, Esther, Albinarrate, Ania, Fondarella, Ana M., Gallego-Ligorit, Lucia, Torrijos, Luisa Lacosta, Bandschapp, Oliver, Blum, Andrea A., Seeberger, Esther, Steiner, Luzius A., Thomann, Alessandra E., Frei, Seraina, Hoehn, Susan, Baenziger, Bertram, Capaldo, Giuliana, Christ, Daniel, Doerig, Ramon, Hodel, Daniel, Weiss, Andreas, Witt, Lukas, Schumacher, Philippe, Siebing, Dirk A., Akbuz, Seyma Orcan, Bengisun, Zuleyha Kazak, Kazbek, Baturay K., Koksoy, Ulku C., Terzi, Engin Z., Yilmaz, Hakan, Alkis, Neslihan, Turhan, Sanem Cakar, Meco, Basak C., Hajiyeva, Konul, Guclu, Cigdem Yildirim, Ergil, Jülide, Ceran, Emine Unal, Ozcelik, Menekse, Bülent, Atik, Gökhan, Kilinc, Saracoglu, Kemal T., Kir, Bunyamin, Koltka, Kemalettin, Sivrikoz, Nükhet, Dincer, Pelin Corman, Canbolat, Nur, Kudsioglu, Turkan, Aydin, Gaye, Mucuoglu, Ceren Aygün, Inal, Duriye G., Kucukguclu, Semih, Egilmez, Ayse I., Kozanhan, Betul, Yildiz, Munise, Pinar, Hüseyin U., Erdivanlı, Başar, Hızal, Ayşe, Karagöz, Emre, Kazdal, Hızır, Özdemir, Abdullah, Tas Tuna, Ayca, Gulgun, Gamze, Oleg, Dolya, Hoeft, Andreas, MUMC+: MA Anesthesiologie (3), RS: MHeNs - R3 - Neuroscience, and MUMC+: MA Anesthesiologie (9)

Subjects
Aged, 80 and over, Male, Patient, Frailty, Preoperative assessment, Surgical outcomes, Europe, Hospitalization, Older, Anesthesiology and Pain Medicine, Outcome Assessment, Health Care, Humans, Female, Surgery, Prospective Studies, Derivation, Mortality, Aged
Abstract

OBJECTIVES The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality. DESIGN A prospective cohort study. SETTING European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period. PATIENTS Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia. MAIN OUTCOME MEASURES The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan–Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect. RESULTS Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days. CONCLUSIONS The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov. ispartof: European Journal Of Anaesthesiology vol:39 issue:3 pages:198-209 ispartof: location:England status: published

Published
2022

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