Survival curve identifies critical period for postoperative mortality in cardiac patients undergoing emergency general surgery

Diego Ramos Martines,Leonardo Zumerkorn Pipek,Gustavo Heluani Antunes De Mesquita,Alberto Meyer,Fernanda Nii,Antonio Carlos Mugayar Bianco,Bárbara Justo Carvalho,Kayo Augusto De Almeida Medeiros,Gustavo B F Oliveira,Leandro Ryuchi Iuamoto

doi:10.1038/s41598-020-72647-7

Abstract

The number of non-cardiac major surgeries carried out has significantly increased in recent years to around 200 million procedures carried out annually. Approximately 30% of patients submitted to non-cardiac surgery present some form of cardiovascular comorbidity. In emergency situations, with less surgery planning time and greater clinical severity, the risks become even more significant. The aim of this study is to determine the incidence and clinical outcomes in patients with cardiovascular disease submitted to non-cardiac surgical procedures in a single cardiovascular referral center. This is a prospective cohort study of patients with cardiovascular disease submitted to non-cardiovascular surgery. All procedures were carried out by the same surgeon, between January 2006 and January 2018. 240 patients included were elderly, 154 were male (64%), 8 patients presented two diagnoses. Of the resulting 248 procedures carried out, 230 were emergency (92.8%). From the data obtained it was possible to estimate the day from which the occurrence of mortality is less probable in the postoperative phase. Our research evaluated the epidemiological profile of the surgeries and we were able to estimate the survival and delimit the period of greatest risk of mortality in these patients. The high rate of acute mesenteric ischemia was notable, a serious and frequently fatal condition.

Highlights

The number of non-cardiac major surgeries carried out has significantly increased in recent years to around 200 million procedures carried out annually
According to European Society of Cardiology and European Society of Anaesthesiology data, approximately 30% of patients submitted to non-cardiac surgery present some form of cardiovascular comorbidity[2], with a resulting greater risk of complications or a fatal cardiovascular event in the postoperative period
With less surgery planning time and greater clinical severity, the risks become even more significant, multiplying the incidence of myocardial infarction or mortality because of postoperative cardiovascular conditions by between 2.5 and 4 times[3]. This increased risk can be identified by the American Society of Anesthesiologists (ASA)[4] score, among others

Summary

Introduction

The number of non-cardiac major surgeries carried out has significantly increased in recent years to around 200 million procedures carried out annually. According to European Society of Cardiology and European Society of Anaesthesiology data, approximately 30% of patients submitted to non-cardiac surgery present some form of cardiovascular comorbidity[2], with a resulting greater risk of complications or a fatal cardiovascular event in the postoperative period. With less surgery planning time and greater clinical severity, the risks become even more significant, multiplying the incidence of myocardial infarction or mortality because of postoperative cardiovascular conditions by between 2.5 and 4 times[3]. This increased risk can be identified by the American Society of Anesthesiologists (ASA)[4] score, among others. These initiatives show the relevance of the clinical conditions found in cardiopathic patients and their evolution in the postoperative period

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Conclusion