Prevalence and risk factors for cardiac arrest and myocardial infarction after pelvic reconstructive surgery: a national, multi-institutional, surgical database study

Abstract

There is limited data available regarding the risk for perioperative cardiac morbidity following pelvic reconstructive surgery (PRS). We sought to determine the incidence of cardiac arrest and myocardial infarction within 30days of pelvic organ prolapse (POP) surgery and determine which factors may contribute to an increased risk of these complications. Using the American College of Surgeons National Quality Improvement Program (NSQIP) database, we identified patients who underwent PRS procedures between 2010 to 2015 using Current Procedural Terminology (CPT) codes. Patient demographics and clinical and surgical factors were obtained. Patients who experienced myocardial infarction or cardiac arrest (MICA) were compared with patients without these complications. Differences between groups were calculated using the chi-square and Student's t test. Stepwise backward multivariate logistic regression was used to identify factors associated with acute cardiac morbidity. A total of 46, 367 women were identified. The incidence of MICA was 0.11% and of death was 0.01% for the entire cohorot. Age >70years [adjusted odds ratio (aOR)=2.99, 95% confidence interval (CI) 1.56-5.73], length of stay >1 day (aOR=3.34, 95% CI 1.70-6.40), dependent functional status (aOR=5.99 95% CI 1.95-16.32), hypertension (aOR=2.86, 95% CI 1.36-6.04), American Society of Anesthesiologists (ASA) class 3 (aOR=2.01, 95% CI 1.10-3.64), and inpatient status (aOR=4.35, 95% CI 1.78-10.49). The rate of MICA is low following PRS. Additional studies are necessary to determine whether more extensive preoperative cardiac evaluation is warranted in this patient population.