Usefulness of surgical parameters as predictors of postoperative cardiac events in patients undergoing non-cardiac surgery.

BACKGROUND  Postoperative cardiac events are an important cause of morbidity and mortality in patients undergoing non-cardiac surgery. Predictive values of surgical parameters with respect to development of postoperative cardiac events have not been well investigated. METHODS AND RESULTS  This study included 1,016 consecutive patients who underwent cardiac consultation prior to elective non-cardiac surgery. A major adverse cardiac event (MACE) was defined as a composite of all-cause death, non-fatal myocardial infarction, and pulmonary edema within 30 days of surgery. There were 95 postoperative MACEs (9.4%). Patients with postoperative MACE were significantly older, and had significantly higher revised cardiac risk index than those without. ST-T change on electrocardiogram (ECG) was significantly higher in patients with postoperative MACE. Of the surgical parameters, significant differences in surgery time (317±211min vs. 189±112min, P<0.001), postoperative hemoglobin (10.7±1.9g/dl vs. 11.3±1.8g/dl, P=0.007), risk of surgery (P<0.001), and transfusion (37.6% vs. 6.6%, P<0.001) were observed between the 2 groups. On multivariate logistic regression analysis, surgery time (odds ratio [OR], 1.004; 95% confidence interval [CI]: 1.003-1.006, P<0.001) and need for transfusion (OR, 4.578; 95% CI: 2.599-8.065, P<0.001), as well as age and ST-T change on ECG were independent predictors of postoperative MACE. CONCLUSIONS  Surgical parameters, including surgery time and transfusion, can strongly predict development of postoperative MACE in patients undergoing non-cardiac surgery.