Multivariable predictors of postoperative cardiac adverse events after general and vascular surgery: results from the patient safety in surgery study.
ABSTRACT Cardiac adverse events (CAEs) are relatively infrequent, but highly lethal, after noncardiac operations. The value of available risk scoring systems is uncertain and these systems can be outdated. We used the Patient Safety in Surgery Study database to develop and test a model to predict patient risk for CAEs after general and vascular surgical operations.
As part of the Patient Safety in Surgery Study, following the National Surgical Quality Improvement Program's protocol, multiple demographic, preoperative, perioperative, and outcomes variables were measured during a 3-year period. Data from 128 Veterans Affairs medical center hospitals and from 14 academic medical centers on 183,069 patients were used in a logistic regression analysis to model multivariable predictors of serious CAEs (cardiac arrest or acute myocardial infarction within 30 days of operation).
CAEs occurred in 2,362 patients (1.29%) and of these, 59.44% expired. Multivariable stepwise logistic regression identified 20 independent predictors of CAEs, which excluded most cardiac-specific risk factors. The most important multivariable predictors of CAE were American Society of Anesthesiologists physical status classification, work relative value units of the most complex procedure, age, and type of operation. A risk prediction scoring system using the logistic regression odds ratios proved to be a useful prediction tool when tested using a random sample from the database.
CAEs after noncardiac operations are relatively infrequent but highly lethal. Operation type and urgency and American Society of Anesthesiologists physical status assessment are important independent predictors of cardiac morbidity, but angina, recent MI, and earlier cardiac operation are not. A prediction scoring system based on the Patient Safety in Surgery Study multivariable odds ratios is likely to be predictive of future events in a similar population requiring noncardiac procedures. This risk model can also serve as a tool to measure quality and effectiveness of care by providers who perform noncardiac operations.
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ABSTRACT: Postoperative myocardial infarction (poMI) is a serious and costly complication. Multiple risk factors for poMI are known, but the effect of anemia and cardioprotective medications have not been defined in real-world surgical practice.Surgery 10/2014; 156(4):1018-29. DOI:10.1016/j.surg.2014.06.055 · 3.11 Impact Factor
Current Problems in Surgery 11/2014; 51(11):441-66. DOI:10.1067/j.cpsurg.2014.10.003 · 1.42 Impact Factor
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ABSTRACT: Background: Operative procedural training is a key component of orthopaedic surgery residency. The influence of intraoperative resident participation on the outcomes of surgery has not been studied extensively using large, population-based databases. Methods: We identified 30,628 patients who underwent orthopaedic procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program. Outcomes as measured by perioperative complications, readmission rates, and mortality within thirty days were compared for cases with and without intraoperative resident involvement. Results: Logistic regression with propensity score analysis revealed that intraoperative resident participation was associated with decreased rates of overall complications (odds ratio, 0.717 [95% confidence interval, 0.657 to 0.782]), medical complications (odds ratio, 0.723 [95% confidence interval, 0.661 to 0.790]), and mortality (odds ratio, 0.638 [95% confidence interval, 0.427 to 0.951]). Resident presence in the operating room was not predictive of wound complications (odds ratio, 0.831 [95% confidence interval, 0.656 to 1.053]), readmission (odds ratio, 0.962 [95% confidence interval, 0.830 to 1.116]), or reoperation (odds ratio, 0.938 [95% confidence interval, 0.758 to 1.161]). A second analysis by propensity score stratification into quintiles grouped by similar probability of intraoperative resident presence showed resident involvement to correlate with decreased rates of overall and medical complications in three quintiles, but increased rates of overall and medical complications in one quintile. All other outcomes were equivalent across quintiles. Conclusions: Orthopaedic resident involvement during surgical procedures is associated with lower risk of perioperative complications and mortality in the National Surgical Quality Improvement Program database. The results support resident participation in the operative care of orthopaedic patients.The Journal of Bone and Joint Surgery 08/2014; 96(15):e131. DOI:10.2106/JBJS.M.00660 · 4.31 Impact Factor