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Abstract
Stress-related cardiomyopathy can develop during the postoperative period due to surgery-related stress factors. However, the prevalence and risk factors for this condition are not yet known. During a retrospective, observational study, patients older than 19 years who underwent procedures from January 2011 to December 2015 at a tertiary hospital were included. The main aim was to identify the prevalence and related risk factors for postoperative stress-related cardiomyopathy. To estimate the incidence per risk factor, univariate and multivariate Poisson regression analyses were performed. During the 5-year period, 95,840 patients older than 19 years underwent 125,314 procedures, and the prevalence of postoperative stress-related cardiomyopathy was 17.74 per 100,000 (95% confidence interval, 9.31–26.17), with an in-hospital mortality of 23.5%. As a result, three risk factors were significantly associated: preoperative American Society of Anesthesiologists classification (incidence rate ratio, 5.901 for American Society of Anesthesiologists class 1–2 [ref] versus 3–6; 95% confidence interval,1.289–27.002; P = 0.022); preoperative body mass index (incidence rate ratio, 1.247 for increases of 18.5 [ref] to 30; 95% confidence interval, 1.067–1.458; P = 0.006); and preoperative serum sodium (incidence rate ratio, 0.830 for each increase of 10 mmol/L from 130; 95% confidence interval, 0.731–0.942; P = 0.004). The incidence rate ratio for age for each increase of 10 years from 50 years was 1.057, but it was not statistically significant (P = 0.064). Our study found that the prevalence of postoperative stress-related cardiomyopathy was 17.74 patients per 100,000 adult patients over the course of 5 years, with four cases of in-hospital mortality. Factors that increased the risk of postoperative stress-related cardiomyopathy included higher American Society of Anesthesiologists class (≥3), preoperative hyponatremia, and higher preoperative body mass index.
Highlights
Stress-related cardiomyopathy (SRC) is a disease that was first reported in Japan in the early 1990s [1]
The mechanism for the development of SRC is hypothesized to be sympathetic stimulation of the myocardium of the heart associated with increased catecholamine [2, 3], and it mostly develops in postmenopausal women and patients with neurologic injuries [4, 5]
We explored the risk factors expected to contribute to the development of SRC using Poisson regression, which is known to be suitable for modeling event data for rare occurrences
Summary
Stress-related cardiomyopathy (SRC) is a disease that was first reported in Japan in the early 1990s [1]. Postoperative pain disrupts the emotional stability of patients and can increase sympathetic tone [14]. Studies of the prevalence of and risk factors for SRC during the postoperative period and involving a large population have not been conducted. One study in 2010 reported 17 cases of procedure-related SRC over the course of 63 months; the focus of this study was on the outcome of SRC and clinical presentation rather than on the prevalence and risk factors [18]. Additional research regarding the prevalence and risk factors for postoperative SRC is needed.
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