A novel approach to perioperative risk assessment for patients with pulmonary hypertension
Rationale Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesised that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk. Method...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2021-07-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/7/3/00257-2021.full |
| _version_ | 1818733638872727552 |
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| author | Hussein J. Hassan Traci Housten Aparna Balasubramanian Catherine E. Simpson Rachel L. Damico Stephen C. Mathai Paul M. Hassoun Jochen Steppan Peter J. Leary Todd M. Kolb |
| author_facet | Hussein J. Hassan Traci Housten Aparna Balasubramanian Catherine E. Simpson Rachel L. Damico Stephen C. Mathai Paul M. Hassoun Jochen Steppan Peter J. Leary Todd M. Kolb |
| author_sort | Hussein J. Hassan |
| collection | DOAJ |
| description | Rationale
Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesised that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk.
Methods
We identified patients in the Johns Hopkins PH Center Registry that had noncardiac surgery (including endoscopies) between September 2015 and January 2020. We collected information on preoperative patient-level and procedural variables and used logistic regression to evaluate associations with a composite outcome of death within 30 days or serious postoperative complication. We generated composite patient-level risk assessment scores for each subject and used logistic regression to estimate the association with adverse surgical outcomes. We adjusted multivariable models for inherent procedural risk of major cardiovascular events and used these models to generate a numerical PH perioperative risk (PHPR) score.
Results
Among 150 subjects, 19 (12.7%) reached the primary outcome, including 7 deaths (4.7%). Individual patient-level and procedural variables were associated with the primary outcome (all p<0.05). A composite patient-level risk assessment score built on three noninvasive parameters was strongly associated with reduced risk for poor outcomes (OR=0.4, p=0.03). This association was strengthened after adjusting the model for procedural risk. A PHPR score derived from the multivariable model stratified patients into low (0%), intermediate (≤10%), or high (>10%) risk of reaching the primary outcome.
Conclusion
Composite PAH risk assessment scores can predict perioperative risk for PH patients after accounting for inherent procedural risk. Validation of the PHPR score in a multicentre, prospective cohort is warranted. |
| first_indexed | 2024-12-17T23:52:39Z |
| format | Article |
| id | doaj.art-2e789292d7b040519c02e159a979e49c |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-17T23:52:39Z |
| publishDate | 2021-07-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-2e789292d7b040519c02e159a979e49c2022-12-21T21:28:09ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-07-017310.1183/23120541.00257-202100257-2021A novel approach to perioperative risk assessment for patients with pulmonary hypertensionHussein J. Hassan0Traci Housten1Aparna Balasubramanian2Catherine E. Simpson3Rachel L. Damico4Stephen C. Mathai5Paul M. Hassoun6Jochen Steppan7Peter J. Leary8Todd M. Kolb9 Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA Rationale Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesised that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk. Methods We identified patients in the Johns Hopkins PH Center Registry that had noncardiac surgery (including endoscopies) between September 2015 and January 2020. We collected information on preoperative patient-level and procedural variables and used logistic regression to evaluate associations with a composite outcome of death within 30 days or serious postoperative complication. We generated composite patient-level risk assessment scores for each subject and used logistic regression to estimate the association with adverse surgical outcomes. We adjusted multivariable models for inherent procedural risk of major cardiovascular events and used these models to generate a numerical PH perioperative risk (PHPR) score. Results Among 150 subjects, 19 (12.7%) reached the primary outcome, including 7 deaths (4.7%). Individual patient-level and procedural variables were associated with the primary outcome (all p<0.05). A composite patient-level risk assessment score built on three noninvasive parameters was strongly associated with reduced risk for poor outcomes (OR=0.4, p=0.03). This association was strengthened after adjusting the model for procedural risk. A PHPR score derived from the multivariable model stratified patients into low (0%), intermediate (≤10%), or high (>10%) risk of reaching the primary outcome. Conclusion Composite PAH risk assessment scores can predict perioperative risk for PH patients after accounting for inherent procedural risk. Validation of the PHPR score in a multicentre, prospective cohort is warranted.http://openres.ersjournals.com/content/7/3/00257-2021.full |
| spellingShingle | Hussein J. Hassan Traci Housten Aparna Balasubramanian Catherine E. Simpson Rachel L. Damico Stephen C. Mathai Paul M. Hassoun Jochen Steppan Peter J. Leary Todd M. Kolb A novel approach to perioperative risk assessment for patients with pulmonary hypertension ERJ Open Research |
| title | A novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| title_full | A novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| title_fullStr | A novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| title_full_unstemmed | A novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| title_short | A novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| title_sort | novel approach to perioperative risk assessment for patients with pulmonary hypertension |
| url | http://openres.ersjournals.com/content/7/3/00257-2021.full |
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