Perioperative Cardiac Complications Research Articles

Statin use in total joint arthroplasty: a systematic review

Introduction: There has been increased interest in the use of Statins in total hip and knee arthroplasty (THA and TKA) patients to improve outcomes and reduce postoperative complications. This study was performed to systematically review the evidence on Statin use in total joint arthroplasty, specifically its benefits and complications. Methods: Adhering to the PRISMA guidelines, a systematic review of PubMed, Embase, Scopus, Web of Science, and the Cochrane database was performed to find studies reporting on the effects of Statin use on outcomes of THA and TKA. Two authors independently selected relevant papers to include. Results: A total of 18 papers were included in the final analysis. Most were retrospective studies, with heterogeneous patient selection and outcome measures. The evidence on the risks and benefits of Statin use on outcomes of total joint arthroplasty was very limited and heterogeneous. Studies were focusing on perioperative cardiac outcomes, clinical outcomes and complications, renal, pulmonary, and gastrointestinal outcomes. Due to the heterogeneity of reported data, a formal meta-analysis was not possible. Conclusions: There is some evidence in the literature suggesting that perioperative use of Statins, especially in Statin-naïve patients, may reduce cardiac (e.g. atrial fibrillation) and noncardiac (e.g. delirium) complications, while not increasing the risk of muscle or liver toxicity. The authors also found low levels of evidence that Statin use may reduce the long-term risk for revision surgery and osteolysis.

Association Between Chronic Liver Disease and Adverse In-Hospital Outcomes in Patients Undergoing CABG: A Propensity Score-Matched Analysis

Despite a 30% decline in the rate over the last decade, coronary artery bypass graft (CABG) surgery remains a common major surgical procedure with significant morbidity and mortality. Chronic liver disease (CLD) patients, with increased survival rates due to medical advancements, are now frequently being considered for CABG, bearing higher perioperative risks. This study investigates the association between CLD and in-hospital outcomes in CABG patients using retrospective data from the National Inpatient Sample (NIS) database (2016-2020) including 7,945 CLD patients undergoing CABG that were propensity score matched with an equivalent number of patients with no CLD undergoing CABG. Clinical variables were extracted using corresponding ICD-10 codes and multivariable logistic and linear regression models were used to assess in-hospital mortality, complications, and length of stay. The overall mortality rate was 5.5% (8.6% in the CLD group with cirrhosis, 5.9% CLD group without cirrhosis, and 2.8% in the non-CLD group, p<0.001). CLD with cirrhosis was associated with higher odds of mortality (AOR= 4.21, 95% CI [3.61, 4.94]) and length of stay (β = 1.03, 95% CI [1.01, 1.05]). CLD patients with cirrhosis demonstrated higher odds of perioperative cardiac complications (cardiac arrest, ventricular arrhythmias, tamponade, and shock), thromboembolic events, gastrointestinal bleeding, bowel ischemia, acute kidney injury, pneumonia, and sepsis. This study reveals a substantial impact of CLD on adverse outcomes in CABG patients, emphasizing the need for tailored preoperative assessments and postoperative care.

The effect of type of anesthesia (general versus spinal) on postoperative levels of brain natriuretic peptide in parturient women with cardiovascular diseases undergoing cesarean section and related cardiac impacts

ABSTRACT Background Dealing with parturient women with cardiac disease is still a challenge for anesthesiologists due to the presence of physiologic burden of pregnancy in addition to the already existing compromised cardiovascular system. A variety of cardiac indices have been utilized to forecast the risk of perioperative cardiac complications, yet limitations in their predictive value exist. Perioperative brain natriuretic peptide (BNP) level is used as a prognosticator of cardiac complications following surgery in cardiac and non-cardiac individuals. Aim of study To compare the effect of general and spinal anesthesia during cesarean section in parturient with cardiac disease on BNP levels and on predicting adverse cardiac events. Methods Thirty cardiac parturient with cesarean section were assigned randomly into two groups of equal size. Group A: participants received general anesthesia (GA); Group B: participants received spinal anesthesia. Preoperative and 2 and 24 h postoperative BNP levels were measured. Intraoperative and 24 h postoperative cardiac complications were observed. Results Preoperative and 2 and 24 h postoperative BNP mean levels were similar in the two groups. In each group, the 2 and 24 h postoperative rise in BNP mean levels was insignificant compared to the preoperative mean levels of BNP. Incidence of complications was comparable in both groups, but it was associated with the already high preoperative levels of BNP. Conclusions The study concludes that safely conducted certain type of anesthesia has no effect on the perioperative BNP levels nor incidence of complications which is associated with the already high preoperative BNP levels.

Management of Patients with Ischemic Heart Disease in Spine Surgery.

In ischemic heart disease (IHD), the myocardium does not receive enough blood and oxygen. Although the IHD-related mortality rate is decreasing, the risk remains and is a major predictor of cardiac complications following noncardiac surgery. Given the increase in the older population, the number of patients with spinal diseases requiring surgery is increasing. Among these patients, those with underlying IHD or a high risk of cardiac complications before and after surgery are also increasing. Given that cardiac complications following spinal surgery are associated with delayed patient recovery and even death, spinal surgeons should be knowledgeable about overall patient management, including medication therapy in those at high risk of developing perioperative cardiac complications for successful patient care. Before surgery, the underlying medical conditions of patients should be evaluated. Patients with a history of myocardial infarction should be checked for a history of surgical treatments, and the anticoagulant dose should be controlled depending on the surgery type. In addition, the functional status of patients must be examined before surgery. Functional status can be assessed according to the metabolic equivalent of task (MET). More preoperative cardiac examinations are needed for patients who are unable to perform four METs in daily because of the high risk of postoperative cardiac complications. Patients with a history of IHD require appropriate preoperative management and further postoperative evaluation. When considering surgery, spinal surgeons should be knowledgeable about patient care before and after surgery.

Guideline adherence to statin therapy and association with short-term and long-term cardiac complications following noncardiac surgery: A cohort study.

Peri-operative complications are common and associated with high morbidity and mortality. Optimising the use of statins might be of important benefit in peri-operative care and reduce morbidity and mortality. To evaluate adherence to current guideline recommendations regarding statin therapy and its association with peri-operative and long-term cardiac complications. Prospective cohort study. Multicentre study with enrolment from October 2014 to February 2018. Eight thousand one hundred and sixteen high-risk inpatients undergoing major noncardiac surgery who were eligible for the institutional peri-operative myocardial injury/infarction (PMI) active surveillance and response program. Class I indications for statin therapy were derived from the current ESC Clinical Practice Guidelines during the time of enrolment. PMI was prospectively defined as an absolute increase in cTn concentration of the 99th percentile in healthy individuals above the preoperative concentration within the first three postoperative days. Long-term cardiac complications included cardiovascular death and spontaneous myocardial infarction (MI) within 120 days. The mean age was 73.7 years; 45.2% were women. Four thousand two hundred and twenty-seven of 8116 patients (52.1%) had a class I indication for statin therapy. Of these, 2440 of 4227 patients (57.7%) were on statins preoperatively. Adherence to statins was lower in women than in men (46.9 versus 63.9%, P < 0.001). PMI due to type 1 myocardial infarction/injury (T1MI; n = 42), or likely type 2 MI (lT2MI; n = 466) occurred in 508 of 4170 (12.2%) patients. The weighted odds ratio in patients on statin therapy was 1.15 [95% confidence interval (CI) 1.01 to 1.31, P = 0.036]. During the 120-day follow-up, 192 patients (4.6%) suffered cardiovascular death and spontaneous MI. After multivariable adjustment, preoperative use of statins was associated with reduced risk; weighted hazard ratio 0.59 (95% CI 0.41 to 0.86, P = 0.006). Adherence to guideline-recommended statin therapy was suboptimal, particularly in women. Statin use was associated with an increased risk of PMI due to T1MI and lT2MI but reduced risk of cardiovascular death and spontaneous MI within 120 days. Clinicaltrials.gov identifier NCT02573532.

SP10.10 Assessment of coronary artery calcification on pre-operative imaging to predict cardiovascular complications in colorectal cancer patients

Abstract Background All patients undergoing operative management of colorectal cancer have pre-operative Computer Tomography (CT) imaging of thorax to exclude metastatic disease. Incidental coronary artery calcification is rarely reported on CT. There are a variety of risk scores to predict cardiac complications in the peri-operative period. Current cardiac risk stratification tools do not incorporate radiological evidence of coronary artery calcification in their scoring systems. Methods A retrospective review of 100 patients with confirmed or suspected colorectal cancer. Demographic data was collected. A review of pre-operative CT thorax imaging was completed to ordinal score coronary artery calcification into none, mild, moderate and extensive. Peri-operative and post-operative cardiac and non-cardiac complications were documented. Results Seventy-nine percent of patients had evidence of coronary artery calcification on pre-operative CT thorax. 29 mild, 21 moderate, 29 extensive. Seven percent of patients had a cardiac complication and all of these had coronary artery calcification on CT pre-operatively. Twenty-six had non-cardiac complication and 22 of these had evidence of coronary artery calcification on pre-operative CT. Conclusions There is significant burden of coronary artery calcification in this patient population. This corresponds positively with peri- and post-operative cardiac and non-cardiac complications. Identification pre-operatively can help predict cardiac risk and therefore allow pre-operative cardiac optimisation.

The incidence and risk factors of perioperative cardiac complications in noncardiac major surgery in high-altitude areas: A prospective trial in Tibet autonomous region, China.

The risk of perioperative cardiac complications (PCCs) in patients living in high-altitude areas may increase with more adverse clinical outcomes due to the special geographical environment, which has not yet been studied. We aimed to determine the incidence and analyze risk factors for PCCs in adult patients undergoing major noncardiac surgery in the Tibet Autonomous Region. This prospective cohort study enrolled resident patients from high-altitude areas receiving major noncardiac surgery in Tibet Autonomous Region People's Hospital in China. Perioperative clinical data were collected, and the patients were followed up until 30 days after surgery. The primary outcome was PCCs during the operation and within 30 days after the surgery. Logistic regression was used to build the prediction models for PCCs. A receiver operating characteristic (ROC) curve was used to evaluate the discrimination. A prognostic nomogram was constructed to generate a numerical probability of PCCs for patients undergoing noncardiac surgery in high-altitude areas. Among the 196 patients living in high-altitude areas involved in this study, 33 (16.8%) suffered PCCs perioperatively and within 30 days after surgery. Eight clinical factors were identified in the prediction model, including older age (P = 0.028), extremely high altitude above 4,000 m (P = 0.442), preoperative metabolic equivalent (MET) < 4 (P = 0.153), history of angina within 6 months (P = 0.037), history of great vascular disease (P = 0.073), increased preoperative high sensitivity C-reactive protein (hs-CRP) (P = 0.072), intraoperative hypoxemia (P = 0.025) and operation time >3 h (P = 0.043). The area under the curve (AUC) was 0.766 (95% confidence interval: 0.785-0.697). The score calculated from the prognostic nomogram predicted the risk of PCCs in high-altitude areas. The incidence of PCCs in resident patients living in high-altitude areas who underwent noncardiac surgery was high, and the risk factors included older age, high altitude above 4,000 m, preoperative MET < 4, history of angina within 6 months, history of great vascular disease, increased preoperative hs-CRP, intraoperative hypoxemia, and operation time >3 h. The prognostic nomogram of this study could help to assess the PCCs for patients in high-attitude areas undergoing noncardiac surgery. ClinicalTrials.gov ID: NCT04819698.

Preoperative advanced cardiology evaluation in adult non-cardiac surgery: A retrospective cohort study

Background/Aim: Advanced cardiology evaluation (ACE) is the most frequently requested consultation during preoperative medical evaluations (PMEs) performed in anesthesia outpatient clinics. However, the efficacy and results of this ACE request are unclear. We aimed to show the frequency of ACE requested during PME of patients undergoing non-cardiac surgery (NCS) and its effect on diagnosis, treatment process, and surgical time planning. Methods: This is a single-center, retrospective cohort study of 300 patients aged 18 years and older who need ACE. Medical charts were reviewed for patient characteristics and diagnosis, planned surgery type, surgical intervention risk, revised cardiac risk index (RCRI), other consultation records, cardiology consultation indication, risk group determined by the cardiologist, metabolic equivalent (METs), and anticoagulant use were recorded. Results: We analyzed the data of 300 patients for whom ACE was requested from 9825 patients who underwent PME. The mean age was 66 (12) years, and the most common age range was 60–79 years (62.7%). The proportion of patients with METs ≤4 was 11% (n=33). The most common additional consultation was chest disease (10%), and the most common co-morbidity was hypertension (61.6%). The most common reason for consultation was a history of ischemic heart disease (50%). According to the revised cardiac risk index, most patients were in class 2, while according to the cardiology consultation outcome grade, most patients were in the intermediate risk group. It was observed that the cardiology consultation process was mostly completed on the same day (255 patients, 85%), and the use of anticoagulant drugs was mostly left to the individual evaluation of the surgeon (143 patients, 47.7%). Conclusion: PME should be given due care to prevent perioperative cardiac complications in patients undergoing NCS. More careful patient assessments are needed during ACEs. This would allow for more accurate risk stratifications and, if necessary, the ordering of additional testing.

Continuous femoral nerve block enhances outcome of spinal anaesthesia in preventing perioperative cardiac complications in patients with cardiac risk

ABSTRACT Background Elevated brain natriuretic peptide (BNP) is crucial to detect perioperative adverse cardiovascular events in patients with cardiac risk, even at low elevation of BNP level or when myocardial necrosis has not been already established. This study aims to compare between two anaesthesia methods in preventing perioperative myocardial infarction for patients having cardiac risk undergoing total knee arthroplasty (TKA). Patients and methods Fifty adult patients planned for TKA with risk factors as ischemic heart disease, diabetics, hypertensive, heavy smokers or body mass index ≥ 35 were categorized randomly into two groups. Group (S): received spinal anaesthesia followed by continuous ultrasound guided femoral nerve block once spinal motor blockade had been resolved. Group (G): received combined general and lumber epidural anaesthesia. BNP, cardiac troponins, pain severity, analgesic consumption, patients’ satisfaction and adverse cardiac events were observed preoperatively and extended to 2 days postoperatively. Results Baseline readings of BNP and cardiac troponins were comparable in both members. At 24 and 48 hours postoperatively, it decreased significantly in group S compared to group G. Mean Visual analogue score was significantly lower in group S comparative to group G at all times except at 40 and 48 hours postoperatively. Morphine utilization was significantly lower in group S. Patients in group S were significantly more satisfied than those in group G. Conclusions The use of spinal anaesthesia with continuous femoral nerve block can reduce the prevalence of perioperative myocardial infarction in patients with cardiac risk undergoing TKA.

Preoperative Transthoracic Echocardiography Predicts Cardiac Complications in Elderly Patients with Coronary Artery Disease Undergoing Noncardiac Surgery.

PurposeGuidelines have not recommended routine transthoracic echocardiography (TTE) for elderly patients prior to noncardiac surgery. We aimed to evaluate the significance of preoperative TTE to predict perioperative cardiac complications (PCCs) for elderly patients with coronary artery disease (CAD) undergoing noncardiac surgery.Patients and methodsWe retrospectively reviewed 2204 patients over 65 years of age with CAD who underwent TTE before intermediate- or high-risk noncardiac surgery in a teaching hospital in China between September 2013 and August 2019. The revised cardiac risk index (RCRI) was assessed. PCCs comprised acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Logistic regression was used to build the prediction model for PCCs. Discrimination was evaluated using receiver operating characteristic curves, and a nomogram of the predictive model was constructed.ResultsPCCs occurred in 189 (8.6%) patients. Multivariable analysis showed that eight clinical risk factors (age, history of myocardial infarction, insulin therapy for diabetes, New York Heart Association classification, preoperative serum creatinine, preoperative electrocardiogram ST-T abnormality and pathological Q wave, and American Society of Anesthesiologists classification) and five TTE parameters (left atrial anteroposterior dimension, left ventricular ejection fraction, left ventricular diastolic dysfunction, pulmonary hypertension, and regional ventricular wall motion abnormality) were associated with PCCs. The receiver operating characteristic curve for the clinical plus TTE model provided better discrimination for PCCs compared with the RCRI model (area under the curve: 0.731 vs 0.564; P < 0.001) and the clinical model (area under the curve: 0.731 vs 0.697, P = 0.001), respectively. The clinical plus TTE model was presented as a prognostic nomogram.ConclusionPreoperative TTE may help predict PCCs in elderly patients with CAD undergoing noncardiac surgery, and the prognostic nomogram from this study appeared to be useful for the assessment of perioperative cardiac risk.

Cardiac Complications After 3-Column Osteotomy for Adult Spinal Deformity Patients With Formal Cardiac Clearance: Identifying Key Risk Factors and Threshold Cutoffs Via Recursive Partitioning Analysis.

Despite formal cardiac clearance, a subset of 3-column osteotomy (3CO) patients still experience cardiac complications (CCs). To define the incidence and risk factors for CC in 3CO patients who had formal cardiac clearance and assess the utility of the Revised Cardiac Risk Index (RCRI) and preoperative metabolic equivalent (MET) functional ability in predicting perioperative CC. Patients with adult spinal deformity (ASD) who underwent 3CO deformity correction from 2006 to 2019 were retrospectively reviewed. Multivariate and recursive partitioning analyses were performed to assess risk factors. A total of 390 patients with ASD were included. The mean age was 64.6 years, and 60.3% were female. The CC rate was 9.7%. Patients with CCs were older ( P &lt; .001), had an increased history of heart disease ( P = .001), and higher blood loss ( P = .045). RCRI score ( P = .646) or MET functional ability ( P = .493) were not associated with CC. On multivariate analysis, age ( P &lt; .001), blood loss ( P = .008), and prior spinal fusion ( P = .025) were independent risk factors for CC. Patients age older than 81 years had a significantly higher CC rate than those younger than 81 years. In patients age 81 years and younger, if blood loss was &gt;3900 mL, CC rate was significantly higher. Among patients age 81 years and younger and with &gt;3900 mL blood loss, CC rate is significantly higher in patients with ejection fraction (EF) ≤54.5%. RCRI and MET functional ability are limited risk assessment tools in ASD 3CO patients with formal cardiac clearance. Patients older than 81 years are at high risk for CC. In younger patients, cardiac EF and blood loss are significant components to risk stratify for CC.

Cardiopulmonary exercise testing for cardiovascular risk assessment in patients undergoing gastric and oesophageal cancer surgery: results from a prospective interventional cohort study

BackgroundCardiopulmonary exercise testing (CPET) has shown to be useful for preoperative risk stratification in various types of intra-abdominal and thoracic surgery. However, data about the predictive value of CPET for...

Prevalence of coronary calcification on preoperative computed tomography and its management in thoracic surgery

PurposeWe investigated the preoperative assessment of coronary artery calcification using computed tomography for appropriate intraoperative management to reduce the risk of perioperative cardiac complications during pulmonary resection.MethodsPatients (n = 665) who underwent anatomical lung resection were examined. The extent of preoperative asymptomatic coronary artery stenosis or cardiac complications in patients with coronary artery calcification was assessed. In addition, the risk factors for perioperative cardiac complications were determined.ResultsCoronary artery calcification was detected in 233 (35.0%) asymptomatic patients. Nineteen (8.2%) patients with coronary artery calcification had coronary artery stenosis ≥ 75%. Percutaneous coronary intervention was performed preoperatively (n = 3) and postoperatively (n = 10), and preoperative drug intervention was performed in 10 cases. One case of severe postoperative cardiac complications and 20 cases of mild postoperative cardiac complications, including those without coronary artery calcification, occurred. Patients with calcified coronary arteries were at risk of cardiovascular complications in the perioperative period. However, patients with coronary artery calcification who underwent preoperative cardiology intervention had no significant perioperative cardiovascular complications.ConclusionsCoronary artery calcification detected on preoperative computed tomography is a risk factor for perioperative cardiovascular complications. Early intervention may reduce the risk of such complications.

Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery.

The current European guidelines recommend that a preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak. To evaluate the association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures. This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient, a preoperative 12-lead ECG was evaluated by two experienced clinicians following the Polish Cardiac Society recommendations. We performed routine perioperative troponin monitoring at five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, and stroke. The study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59-72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. Multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation, and bundle branch block) was associated with the incidence of MINS or 1-year MACE. This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting the relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high-risk patients.

Dialysis-dependent Patients Have Increased Risk of Myocardial Infarction and Perioperative Death Following Carotid Revascularization Using Transcarotid Artery Revascularization

Dialysis-dependent patients have been reported to have high rates of stroke and death following carotid revascularization; however, recent data suggests that outcomes for the treatment of carotid stenosis in dialysis-dependent patients may be better than previously surmised. The effect of dialysis dependence on outcomes following transcarotid artery revascularization (TCAR) remains unclear. We aimed to study outcomes following the treatment of symptomatic and asymptomatic carotid stenosis using TCAR among dialysis-dependent patients. The Vascular Quality Initiative was used to assess all patients undergoing TCAR. Outcomes were compared between dialysis-dependent patients and those who were not. Patients with asymptomatic and symptomatic carotid stenosis were assessed separately. Primary outcomes included perioperative mortality, stroke, and transient ischemic attack (TIA). Secondary outcomes included myocardial infarction, overall cardiac complications, surgical site infection, length of stay, access site complications, cranial nerve injury, and hemodynamic instability. Cardiac complication included myocardial infarction, congestive heart failure and/or dysrhythmias. Univariate and multivariable analysis using multivariable logistic regression and cox regression models were used. A total of 20,927 patients undergoing TCAR were identified from 2016 to 2021. Among patients with asymptomatic carotid stenosis 12,275 (98.6%) were not on dialysis and 173 patients (1.4%) were on dialysis. Among patients with symptomatic carotid stenosis 8348 (98.5%) were not on dialysis, and 128 patients (1.5%) were on dialysis. Among asymptomatic and symptomatic patients, dialysis was not associated with an increased risk of perioperative stroke or TIA (Table). Asymptomatic dialysis-dependent patients had increased risk of perioperative mortality (0.7% vs 4.6%; P < .001), myocardial infarction (0.5% vs 2.3%; P = .002), and cardiac complications (1.9% vs 4.6%; P = .011). All dialysis patients had increased risks of prolonged length of stay. After adjustment, asymptomatic patients remained at increased odds of perioperative mortality (odd ratio [OR], 5.8; 95% confidence interval [CI], 2.2-15.0), stroke/mortality (OR, 2.9; 95% CI, 1.2-6.8), myocardial infarction (OR, 3.3; 95% CI, 1.1-9.2), and overall cardiac complications (OR, 2.2; 95% CI, 1.1-4.6). Perioperative revascularization outcomes among dialysis-dependent patients undergoing TCAR for carotid artery stenosis demonstrate acceptable stroke and TIA, when compared with nondialysis patients. Similar to previous studies studying carotid endarterectomy and carotid artery stenting, dialysis dependence is associated with increased risk of myocardial infarction and perioperative mortality following TCAR. Thus, carotid revascularization should be used selectively in asymptomatic dialysis-dependent patients.TablePerioperative outcomesAsymptomatic (n = 12,448)Symptomatic (n = 8476)No dialysis (n = 12,275, 98.6%)Dialysis (n = 173, 1.4%)P valueNo dialysis (n = 8,348, 98.5%)Dialysis (n = 128, 1.5%)P valuePerioperative mortality650.7%54.6%<.001891.5%22.5%.495Stroke/perioperative mortality1671.9%65.6%.0062334.0%44.9%.658Stroke1130.9%21.2%.7411712.0%21.6%.699TIA500.4%10.6%.722660.8%21.6%.333MI660.5%42.3%.002490.6%00.0%.381Cardiac complication2341.9%84.6%.0111922.3%43.1%.564Surgical site infection30.0%00.0%.83830.0%00.0%.831LOS >2 days146612%4224%<.001308937%6551%.001Access site complications3342.7%84.6%.1302372.8%00.0%.053Cranial nerve injury230.2%00.0%.569290.4%00.0%.496Hemodynamic instability (requiring IV medications).099.064 Hypotension203857%2847%130454%2341% Hypertension151643%3253%112646%3359%IV, intravenous; LOS, length of stay; MI, myocardial infarction; TIA, transient ischemic attack.Neurological events include stroke or TIA; cardiac complications include MI, congestive heart failure, and dysrhythmia. Boldface entries indicate statistical significance. Open table in a new tab

Understanding potential barriers and enablers to a perioperative early phase cell therapy trial

Background aimsEarly-phase cell therapy clinical trials depend on patient and physician involvement, yet barriers can impede their participation. MethodsTo optimize engagement for a planned cell therapy trial to prevent perioperative cardiac complications, the authors conducted semi-structured interviews with at-risk patients and physicians who could potentially be involved in the study. The authors used the theoretical domains framework to systematically identify potential barriers and enablers. ResultsForty-one interviews were conducted to reach data saturation, and four overall potential barriers to participation (themes) were identified. Theme 1 emphasizes that patients and physicians need accessible information to better understand the benefits and risks of the novel therapy and trial procedures and to address misconceptions. Theme 2 underscores the need for clarity on whether the trial's primary purpose is safety or efficacy, as this may influence patient and physician decisions. Theme 3 recognizes the resource and logistic realities for patients (e.g., convenient follow-up appointments) and physicians (e.g., personnel to assist in trial procedures, competing priorities). Theme 4 describes the importance of social influences (e.g., physicians and family, peers/colleagues) that may affect decisions to participate and the importance of patient preferences (e.g., availability of physicians to discuss the trial, including caregivers in discussions). ConclusionsProspectively addressing these issues may help optimize feasibility prior to conducting an expensive, resource-intensive trial.

Incidence and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery.

Background:An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods:This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results:Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (odds ratios (OR): 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (OR: 120.97; 95% CI: 2.12-6898.80). Conclusion:The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Incidence of and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery

Background: An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods: This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results: Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (relative risk: RR, 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (RR, 120.97; 95% CI: 2.12-6898.80). Conclusion: The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Early outcomes of growth friendly instrumentation in children with Williams syndrome.

Although scoliosis and kyphosis have been associated with Williams Syndrome (WS), no previous literature has reported on surgical treatment for early onset scoliosis (EOS) in WS. The aim of this case series is to report on the outcomes of spine deformity surgery in patients with EOS and WS and any perioperative anesthetic or cardiovascular complications. One multicenter database was queried for all patients with WS who underwent growth-friendly (GF) treatment before age 12 between 2000 and 2017. Demographics, surgical, and growth-friendly data were queried. Radiographs were measured for curve magnitude, T1-T12 length, and T1-S1 length. Seven patients were analyzed (3 males, 4 females). Patients were at a median age of 2.8years at initial surgery with median follow-up 3.6years (range 2.0-12years) after index surgery. The initial surgical treatments were as follows: 2 traditional growing rods (TGR), 2 magnetically controlled growing rods (MCGR), and 3 vertical expandable prosthetic titanium ribs (VEPTR). The median duration of growth-friendly treatment was 5.0years (range, 2.6-10.4years) with a median number of 9 device lengthenings. The median improvement in coronal curve magnitude from preoperative to most recent follow-up was 19° (range, 54°-9°). Three patients have completed GF treatment: one underwent definitive fusion, and two are under observation with apparent spontaneous fusion and retain the original GF implants. No peri-operative anesthetic or cardiovascular complications occurred. Few studies have reported on surgical outcomes in WS patients with EOS. In this case series, 6/7 patients experienced curve improvement with growth-friendly spine instrumentation. This study suggests that growth-friendly instrumentation for severe EOS in WS can be used for control of spinal deformity while allowing for further growth. Associated complications were typical of distraction-based EOS surgical treatment. There were 62 total procedures with general anesthesia, but no perioperative cardiac complications occurred.

Incidence of and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery.

Background:An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods:This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results:Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (relative risk: RR, 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (RR, 120.97; 95% CI: 2.12-6898.80). Conclusion:The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.