Abstract
BackgroundSystemic inflammation in patients with malignant disease has been associated with increased risk of cardiovascular events. The pro-inflammatory perturbations following surgical trauma may further promote adverse perioperative cardiovascular events and increase the risk of patients with cancer undergoing major surgery. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. MethodsWe conducted a retrospective cohort study of all patients ≥18 years undergoing emergency laparotomy between 2010 and 2016 at Department of Surgery, Zealand University Hospital, Denmark. Complications were graded according to Clavien-Dindo classification of surgical complications. Multivariate logistic regression analysis was performed to estimate association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. ResultsWe identified 1188 patients ≥18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Cardiovascular death occurred in 17 (1.8%) and 5 (2.0%) patients in the non-malignant and malignant group, respectively. Severe cardiovascular complication graded CD 3–5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications in patients undergoing emergency surgery (OR 0.8, 95% CI; 0.4, 1.5). Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3–5. ConclusionsMalignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.
Highlights
Postoperative surgical and medical complications are common following emergency laparotomy, and perioperative cardiovascular events are the leading cause of morbidity and mortality after non-cardiac surgery.[1,2] Patient age, male sex, and chronic medical conditions such as ischemic heart disease, peripheral vascular disease, diabetes, and renal insufficiency are independent preoperative predictors of myocardial injury after non-cardiac surgery.[3]
We identified 1188 patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease
We found no association between malignancy and postoperative cardiovascular complications
Summary
Postoperative surgical and medical complications are common following emergency laparotomy, and perioperative cardiovascular events are the leading cause of morbidity and mortality after non-cardiac surgery.[1,2] Patient age, male sex, and chronic medical conditions such as ischemic heart disease, peripheral vascular disease, diabetes, and renal insufficiency are independent preoperative predictors of myocardial injury after non-cardiac surgery.[3]. Several studies have shown a possible causal relationship between the occurrence of systemic inflammation in patients with malignant disease and increased risk of cardiovascular events. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. We aimed to identify risk factors for postoperative cardiovascular complications
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