Perioperative Cardiovascular Complications Research Articles

Characteristics and complications of fracture in older adults with chronic kidney disease: a cross-sectional study

BackgroundThe aim of this study was to analyze the clinical characteristics of older fracture patients with chronic kidney disease (CKD) and to determine the risk factors of perioperative cardiovascular complications.MethodsWe retrospectively reviewed clinical data of older fracture patients with CKD admitted to the Third Hospital of Hebei Medical University from January 2016 to October 2021. The data we collected included baseline characteristics and complications. We finally determined the risk factors of perioperative cardiovascular complications by using logistic regression.ResultsWe ended up enrolling 224 patients, and there were 91 (40.6%) males and 133 (59.4%) females, with a median age of 79 years. 80–84 years old was the age group with high incidence of fracture. The majority of fracture occurred indoors (130 cases, 58.0%) and morning (98 cases, 43.8%). Hip fracture was most common (183 cases, 81.7%), of which femoral neck fracture (101 cases, 45.0%) was the most prevalent. The most common comorbid condition was hypertension (171 cases, 76.3%), and anemia was the most common complication (148 cases, 66.1%). Age ≥ 80 years (OR = 2.023, 95% CI 1.110–3.688), previously combined with cardiovascular calcification (OR = 1.901, 95% CI 1.047–3.451) and admission hemoglobin level < 100 g/L (OR = 3.191, 95% CI 1.744–5.838) were independent risk factors of perioperative cardiovascular disease (CVD).ConclusionIt was especially necessary to enhance fracture prevention for CKD. Patients whose age older than 80, hemoglobin less than 100 g/L on admission and have previous cardiovascular calcification are more likely to develop perioperative CVD. Such patients require reasonable decisions during the perioperative period to avoid the occurrence of CVD.

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.

A Survey of Perioperative Vascular Complications in Non-Cardiovascular Surgery in a Teaching Hospital in Western China

Introduction: Perioperative period particularly in the elderly is associated with unstable circulatory status, depending on patients' baseline conditions, anesthetic techniques and medications, as well as types of surgical procedures. Objective: To study the characteristics and risk factors of perioperative cardiovascular, cerebrovascular and renovascular complications in patients ≥ 50 years undergoing non-cardiovascular abdominal and lower limb operations. Methods: Retrospective review of hospital records of 1975 patients operated in the period from January 2004 to June 2005, taken from our hospital archive. Results: Their mean age was 63.1±10.1 years and 44.4% were male. There were 1121 perioperative complications, including acute hypertension (576), arrhythmias (sinus tachycardia, atrio-ventricular block, atrial fribrillation, ventricular fibrillation) (455), acute renal insufficiency (32), coronary artery disease (56) and stroke (2). Nineteen patients (1%) died of multiple organ dysfunction syndrome. The incidence of perioperative complications increased with age. Analgesics were given to 958 patients (48.5%) in postoperative period for pain control. The incidence of perioperative arrhythmias and coronary artery disease in analgesic group was higher than non-analgesic group (p < 0.01). Conclusion: Perioperative vascular complications of patients (particularly in the elderly) are common. More vigilant perioperative evaluation and more efficient perioperative pain control are needed.

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.

Meta-analysis suggests statins reduce mortality after abdominal aortic aneurysm repair.

The necessity and efficacy of statin treatment for abdominal aortic aneurysm (AAA) remains controversial. This systematic review and meta-analysis was conducted to investigate the effects of statin therapy on the outcomes of patients with AAA. The Cochrane library, Embase, and MedLine were searched comprehensively to identify relevant cohort studies and randomized controlled trials. The primary outcomes included short- and long-term mortality after AAA repair, and secondary outcomes included the incidence of perioperative cardiovascular complications, sac shrinkage after endovascular aneurysm repair, and the growth rate of the aneurysms. Short-term mortality was defined as all-cause 30-day or in-hospital postoperative mortality. Long-term mortality was defined as the all-cause mortality at the end of follow-up period (≥1year). A random effects model was used to combine the results of included studies. Forest plots were created to show the pooled results of each outcome. One post hoc analysis of a randomized trial and 36 cohort studies (n= 134,290 patients) were included in this systematic review. The average score of included studies by Newcastle-Ottawa Scale was 7.76. Patients taking or not taking statin therapy were all diagnosed with unruptured AAA, and 59.9% of these patients were given statin therapy. Compared with statin nonusers, patients in statin therapy had significantly lower long-term mortality (odds ratio, 0.67; 95% confidence interval, 0.59-0.75; P< .001; I2= 71.7%), and short-term mortality after aneurysmal repair (odds ratio, 0.51; 95% confidence interval, 0.36-0.73; P< .001; I2= 81.4%). No significant difference was found between patients taking or not taking statin treatment on perioperative cardiovascular complications or sac shrinkage after endovascular aneurysm repair or growth rate of AAA under surveillance. These findings suggest that statin use is associated with a significant decrease in long- and short-term mortality in patients after AAA repair. Based on these results, statin therapy is worth being used in clinical practice for the management of AAA.

STOP-BANG: a Mandatory Tool for Targeted Respiratory Therapy in Bariatric Patients

Identification of patients with obstructive sleep apnea syndrome and high respiratory risk, optimization of the screening algorithm for these patients and administration of preventive non-invasive lung ventilation, makes it possible to prevent the development of perioperative complications, reduce duration of hospital stay and reduce mortality in patients undergoing surgery and bariatric surgery specifically.The objective: to evaluate the effectiveness of STOP-BANG questionnaire for preventive targeted respiratory therapy to reduce the risk of complications in bariatric patients. Subjects and Methods. We examined 60 patients with BMI above 30 kg/m2 referred to elective secondary surgery, the age made 44.2 ± 10.1 years, 23 men and 37 women. Before the operation, patients underwent STOP-BANG questionnaire survey, night respiratory monitoring with the calculation of the apnea/hypopnea index (AHI) and/or saturation during sleep. The standard preoperative examination included clinical and biochemical analyzes.Results. Based on results of STOP-BANG survey, a correlation was revealed between the score and AHI as well as the score and average saturation. The higher score the patients had according to the STOP-BANG questionnaire, the higher AHI was (r = 0.4748, p = 0.002), and the lower mean SpO2 was (r = -0.6958, p &lt; 0.001). Using the ROC analysis, we chose the optimal threshold value - 4 points according to STOP-BANG questionnaire, where the sensitivity of the method was 93% for the AHI, the specificity was 56%, and for the average saturation it was 100% and 63%, respectively. Of the total number of bariatric patients included in the study, 30% required preventive ventilation. In the high respiratory risk group, no significant intraoperative incidents and deaths were reported by the surgical and anesthetic teams. All patients were discharged on time (5‒7 days). Based on the results, a screening procedure has been offered for bariatric patients with high respiratory risk associated with obstructive sleep apnea syndrome.Conclusion. The STOP-BANG questionnaire is a reliable screening tool for high respiratory risk in morbid obese patients. Early diagnosis of high respiratory risk and implementation of preventive ventilation reduces the incidence of perioperative respiratory and cardiovascular complications.

Short-Term Pre-Operative Protein Caloric Restriction in Elective Vascular Surgery Patients: A Randomized Clinical Trial.

(1) Background: Vascular surgery operations are hampered by high failure rates and frequent occurrence of peri-operative cardiovascular complications. In pre-clinical studies, pre-operative restriction of proteins and/or calories (PCR) has been shown to limit ischemia-reperfusion damage, slow intimal hyperplasia, and improve metabolic fitness. However, whether these dietary regimens are feasible and safe in the vascular surgery patient population remains unknown. (2) Methods: We performed a randomized controlled trial in patients scheduled for any elective open vascular procedure. Participants were randomized in a 3:2 ratio to either four days of outpatient pre-operative PCR (30% calorie, 70% protein restriction) or their regular ad-libitum diet. Blood was drawn at baseline, pre-operative, and post-operative day 1 timepoints. A leukocyte subset flow cytometry panel was performed at these timepoints. Subcutaneous/perivascular adipose tissue was sampled and analyzed. Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of whom 11 completed the study. No diet-related reasons for non-completion were reported, and there was no intervention group crossover. The PCR diet induced weight loss and BMI decrease without malnutrition. Insulin sensitivity was improved after four days of PCR (p = 0.05). Between diet groups, there were similar rates of re-intervention, wound infection, and cardiovascular complications. Leukocyte populations were maintained after four days of PCR. (4) Conclusions: Pre-operative PCR is safe and feasible in elective vascular surgery patients.

Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association.

Myocardial injury after noncardiac surgery is defined by elevated postoperative cardiac troponin concentrations that exceed the 99th percentile of the upper reference limit of the assay and are attributable to a presumed ischemic mechanism, with or without concomitant symptoms or signs. Myocardial injury after noncardiac surgery occurs in ≈20% of patients who have major inpatient surgery, and most are asymptomatic. Myocardial injury after noncardiac surgery is independently and strongly associated with both short-term and long-term mortality, even in the absence of clinical symptoms, electrocardiographic changes, or imaging evidence of myocardial ischemia consistent with myocardial infarction. Consequently, surveillance of myocardial injury after noncardiac surgery is warranted in patients at high risk for perioperative cardiovascular complications. This scientific statement provides diagnostic criteria and reviews the epidemiology, pathophysiology, and prognosis of myocardial injury after noncardiac surgery. This scientific statement also presents surveillance strategies and treatment approaches.

Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide

BackgroundAcute kidney injury (AKI) is common after cardiac surgery and is difficult to predict. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is highly predictive for perioperative cardiovascular complications and may also predict renal injury. We therefore tested the hypothesis that preoperative NT-proBNP concentration is associated with renal injury after major cardiac surgery. MethodsWe included 35 337 patients who had cardiac surgery and measurements of preoperative NT-proBNP and postoperative creatinine. The primary outcome was Kidney Disease: Improving Global Outcomes Stages 1–3 AKI. We also separately considered severe AKI, including Stage 2, Stage 3, and new-onset dialysis. ResultsPostoperative AKI occurred in 11 999 (34.0%) patients. Stage 2 AKI occurred in 1200 (3.4%) patients, Stage 3 AKI in 474 (1.3%) patients, and new-onset dialysis was required in 241 (0.7%) patients. The NT-proBNP concentrations (considered continuously or in quartiles) were significantly correlated with any-stage AKI and severe AKI (all adjusted P<0.01). Including NT-proBNP significantly improved AKI prediction (net reclassification improvement: 0.24 [0.22−0.27]; P<0.001) beyond basic models derived from other baseline factors in the overall population. Reclassification was especially improved for higher grades of renal injury: 0.30 (0.25−0.36) for Stage 2, 0.46 (0.37−0.55) for Stage 3, and 0.47 (0.35−0.60) for dialysis. ConclusionsIncreased preoperative NT-proBNP concentrations were associated with postoperative AKI in patients having cardiac surgery. Including NT-proBNP substantially improves AKI predictions based on other preoperative factors.

Mitral Regurgitation in Patients Undergoing Noncardiac Surgery.

Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.

Perioperative risk and antiplatelet management in patients undergoing non-cardiac surgery within 1 year of PCI.

Perioperative cardiovascular complications are important causes of morbidity and mortality associated with non-cardiac surgery, especially in patients with recent percutaneous coronary intervention (PCI). We aimed to illustrate the types and timing of different surgeries occurring after PCI, and to evaluate the risk of thrombotic and bleeding events according to the perioperative antiplatelet management. Patients undergoing urgent or elective non-cardiac surgery within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, or stent thrombosis) at 30 days. Perioperative bleeding was defined as ≥ 2 units of blood transfusion. A total of 1092 surgeries corresponding to 747 patients were classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones, and were associated with an increased risk of both MACE and bleeding. Preoperative interruption of antiplatelet therapy (of any kind) occurred in 44.6% of all NCS and was more likely for procedures occurring later post-PCI and at intermediate risk. There was no significant association between interruption of antiplatelet therapy and adverse cardiac events. Among patients undergoing NCS within 1 year of PCI, perioperative ischemic and bleeding events primarily depend on the estimated surgical risk and urgency of the procedure, which are increased early after PCI. Preoperative antiplatelet interruption was not associated with an increased risk of cardiac events.

Implementation of the Canadian Cardiovascular Society guidelines for perioperative risk assessment and management: an interrupted time series study.

The Canadian Cardiovascular Society (CCS) guidelines for patients undergoing non-cardiac surgery address the lack of standardized management for patients at risk of perioperative cardiovascular complications. Our interdisciplinary group evaluated the implementation of these guidelines. We used an interrupted time series design to evaluate the effect of implementation of the CCS guidelines, using routinely collected hospital data. The study population consisted of elective, non-cardiac surgery patients who were: i) inpatients following surgery and ii) age ≥ 65 or age 45-64 yr with a Revised Cardiac Risk Index ≥ 1. Outcomes included adherence to troponin I (TnI) monitoring (primary) and adherence to appropriate consultant care for patients with elevated TnI (secondary). Exploratory outcomes included cost measures and clinical outcomes such as length of stay. We included 1,421 patients (706 pre- and 715 post-implementation). We observed a 67% absolute increase (95% confidence interval, 55 to 80; P < 0.001) in adherence to TnI testing following the implementation of the guidelines. In patients who had elevated TnI following guideline implementation (n = 64), the majority (85%) received appropriate follow-up care in the form of a general medicine or cardiology consult, all received at least one electrocardiogram, and half received at least one advanced cardiac test (e.g., cardiac perfusion scan, or percutaneous intervention). Our study showed the ability to implement and adhere to the CCS guidelines. Large-scale multicentre evaluations of CCS guideline implementation are needed to gain a better understanding of potential effects on clinically relevant outcomes.

953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

Abstract Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, &amp;gt;10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

Perioperative Stroke Impact on Morbidity and In-Hospital Mortality in Non-Cardiovascular Non-Neurological Surgeries: State Inpatient Database Study

Background: Perioperative stroke, which occurs within 30 days following surgery, can increase morbidity and mortality. The prior might reduce surgical interventions’ clinical effectiveness, carrying significant impact on patients, their families, and healthcare resources utilization. We examined the impact of perioperative stroke on morbidity and mortality in patients undergoing non-cardiovascular non-neurological surgeries. Methods: We performed a retrospective cohort study utilizing State Inpatient Database (SID) available from the Health Cost Utilization Project (HCUP) between 2008 and 2011. The databases above can distinguish between previous and new strokes by providing the “present on admission” variable. We used multivariable logistic regression to assess stroke as an independent predictor of morbidity and mortality after adjusting for other covariables. Results: From the SID, a total of 1,206,057 inpatient discharge records were identified. The incidence of perioperative stroke, in-hospital mortality, and morbidity was 0.14%, 0.54%, and 8.1%. Multivariate logistic regression showed that perioperative stroke is an independent predictor of morbidity (odds ratio (OR) = 5.06, 95% confidence interval (CI) = 4.54 - 5.64, P < 0.001) and in-hospital mortality (OR = 7.26, 95% CI = 6.26 - 8.41, P < 0.001). Other independent predictors were identified, but they showed a weaker association with in-hospital mortality than perioperative stroke, including cardiovascular complications (OR = 4.33, CI = 3.93 - 4.77, P < 0.001). Conclusions: Perioperative stroke is a significant independent risk factor for morbidity and in-hospital mortality following non-cardiovascular, non-neurological surgeries. Patients who developed perioperative stroke had a higher risk of death than perioperative cardiovascular and pulmonary complications. J Neurol Res. 2021;11(1-2):5-13 doi: https://doi.org/10.14740/jnr653

Perioperative Stroke Impact on Morbidity and In-Hospital Mortality in Non-Cardiovascular Non-Neurological Surgeries: State Inpatient Database Study

Background: Perioperative stroke, which occurs within 30 days following surgery, can increase morbidity and mortality. The prior might reduce surgical interventions’ clinical effectiveness, carrying significant impact on patients, their families, and healthcare resources utilization. We examined the impact of perioperative stroke on morbidity and mortality in patients undergoing non-cardiovascular non-neurological surgeries. Methods: We performed a retrospective cohort study utilizing State Inpatient Database (SID) available from the Health Cost Utilization Project (HCUP) between 2008 and 2011. The databases above can distinguish between previous and new strokes by providing the “present on admission” variable. We used multivariable logistic regression to assess stroke as an independent predictor of morbidity and mortality after adjusting for other covariables. Results: From the SID, a total of 1,206,057 inpatient discharge records were identified. The incidence of perioperative stroke, in-hospital mortality, and morbidity was 0.14%, 0.54%, and 8.1%. Multivariate logistic regression showed that perioperative stroke is an independent predictor of morbidity (odds ratio (OR) = 5.06, 95% confidence interval (CI) = 4.54 - 5.64, P &lt; 0.001) and in-hospital mortality (OR = 7.26, 95% CI = 6.26 - 8.41, P &lt; 0.001). Other independent predictors were identified, but they showed a weaker association with in-hospital mortality than perioperative stroke, including cardiovascular complications (OR = 4.33, CI = 3.93 - 4.77, P &lt; 0.001). Conclusions: Perioperative stroke is a significant independent risk factor for morbidity and in-hospital mortality following non-cardiovascular, non-neurological surgeries. Patients who developed perioperative stroke had a higher risk of death than perioperative cardiovascular and pulmonary complications. J Neurol Res. 2021;11(1-2):5-13 doi: https://doi.org/10.14740/jnr653

Impact of Radiation on Cardiovascular Outcomes in Older Resectable Esophageal Cancer Patients With Medicare.

Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients. We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease. Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007). This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.

Survival and Complications After Neoadjuvant Chemotherapy or Chemoradiotherapy for Esophageal Cancer: A Meta-Analysis

Objectives: To identify the effective approach between neoadjuvant chemotherapy (NCT) and chemoradiotherapy (NCRT) by comparing patient survival and complications. Methods: A systematic literature search of articles published between January 1980 and October 2020 was conducted. Data were extracted and analyzed with STATA 12.0. Results: Five randomized trials and 15retrospective studies, including 4529 patients (NCT:2035; NCRT: 2494), were enrolled. Compared with NCT, NCRT provided a higher 3-year survival benefit, higher R0 resection and pathological complete response rates and lower local recurrence and distant metastasis rates, but no increase in 5-year survival. Perioperative mortality and cardiovascular complications were more common in patients with adenocarcinoma. Conclusions: Further studies should concentrate on identifying the optimal neoadjuvant approach and suitable beneficiaries.