Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study
Background Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2024-02-01
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| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-23043.pdf |
| _version_ | 1797335324769124352 |
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| author | Byungjin Choi Ah Ran Oh Jungchan Park Jong-Hwan Lee Kwangmo Yang Dong Yun Lee Sang Youl Rhee Sang-Soo Kang Seung Do Lee Sun Hack Lee Chang Won Jeong Bumhee Park Soobeen Seol Rae Woong Park Seunghwa Lee |
| author_facet | Byungjin Choi Ah Ran Oh Jungchan Park Jong-Hwan Lee Kwangmo Yang Dong Yun Lee Sang Youl Rhee Sang-Soo Kang Seung Do Lee Sun Hack Lee Chang Won Jeong Bumhee Park Soobeen Seol Rae Woong Park Seunghwa Lee |
| author_sort | Byungjin Choi |
| collection | DOAJ |
| description | Background Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed. |
| first_indexed | 2024-03-08T08:35:19Z |
| format | Article |
| id | doaj.art-631d287da89b412f8070487dde93ee2f |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-03-08T08:35:19Z |
| publishDate | 2024-02-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-631d287da89b412f8070487dde93ee2f2024-02-02T01:33:48ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632024-02-01771667610.4097/kja.230438910Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter studyByungjin Choi0Ah Ran Oh1Jungchan Park2Jong-Hwan Lee3Kwangmo Yang4Dong Yun Lee5Sang Youl Rhee6Sang-Soo Kang7Seung Do Lee8Sun Hack Lee9Chang Won Jeong10Bumhee Park11Soobeen Seol12Rae Woong Park13Seunghwa Lee14 Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea Central Research Center of Biomedical Research Institute, Wonkwang University Hospital, Iksan, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea Department of Cardiology, Wiltse Memorial Hospital, Suwon, KoreaBackground Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.http://ekja.org/upload/pdf/kja-23043.pdfcardiac arrhythmiascardiovascular diseasesembolismgeneral surgerymortalitymyocardial infarction |
| spellingShingle | Byungjin Choi Ah Ran Oh Jungchan Park Jong-Hwan Lee Kwangmo Yang Dong Yun Lee Sang Youl Rhee Sang-Soo Kang Seung Do Lee Sun Hack Lee Chang Won Jeong Bumhee Park Soobeen Seol Rae Woong Park Seunghwa Lee Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study Korean Journal of Anesthesiology cardiac arrhythmias cardiovascular diseases embolism general surgery mortality myocardial infarction |
| title | Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study |
| title_full | Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study |
| title_fullStr | Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study |
| title_full_unstemmed | Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study |
| title_short | Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study |
| title_sort | perioperative adverse cardiac events and mortality after non cardiac surgery a multicenter study |
| topic | cardiac arrhythmias cardiovascular diseases embolism general surgery mortality myocardial infarction |
| url | http://ekja.org/upload/pdf/kja-23043.pdf |
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