Thirty-day and one-year predictors of death in noncardiac major surgical procedures
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Haytham M A Kaafarani1, Kamal M F Itani, Jack Thornby
1Michael E. DeBakey Veteran Affairs Medical Center and Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
The American College of Cardiology/American Heart Association (ACC/AHA) risk score predicts 1-year mortality but not 30-day mortality in noncardiac surgery. Procedure risk better predicts short-term mortality.
Area of Science:
- Cardiology
- Anesthesiology
- Surgical Risk Assessment
Background:
- Evaluating the predictive accuracy of cardiac risk classifications for postoperative mortality.
- Assessing various risk factors including procedure risk, smoking, obesity, hyperlipidemia, and renal insufficiency.
Purpose of the Study:
- To determine the predictive value of the American College of Cardiology/American Heart Association (ACC/AHA) cardiac risk classification for all-cause mortality.
- To compare the ACC/AHA classification with other risk factors for predicting 30-day and 1-year postoperative mortality.
Main Methods:
- Screening of 1238 consecutive patients undergoing general anesthesia for noncardiac procedures.
- Preoperative classification using ACC/AHA guidelines and chart review for risk factors.
- Logistic regression analysis to assess mortality predictors.
Main Results:
- Older age and higher procedure risk were associated with increased 30-day mortality (P=0.0012 and P=0.0441).
- ACC/AHA classification showed a positive correlation with 1-year mortality (P=0.0071).
Conclusions:
- ACC/AHA classification predicts 1-year mortality but not 30-day mortality in major noncardiac surgeries.
- Procedure-related risk is a more effective predictor of 30-day postoperative mortality in this patient cohort.
Background:
We evaluated the predictive value of the American College of Cardiology/American Heart Association (ACC/AHA) cardiac risk classification, as well as other potential risk factors (procedure risk, smoking, obesity, hyperlipidemia, and renal insufficiency), on all-cause mortality at 30 days and at 1 year postoperatively.
Methods:
In the year 2000, 1238 consecutive patients undergoing general anesthesia for various noncardiac surgical procedures at the Houston Veterans Affairs Medical Center were screened preoperatively and classified according to the ACC/AHA guidelines. Patients' charts were reviewed for the above-mentioned risk factors.
Results:
A logistic regression analysis demonstrated that older age and higher procedure risk were associated with higher 30-day mortalities (P = 0.0012 and 0.0441, respectively). The ACC/AHA classification was positively correlated with mortality at 1 year (P = 0.0071).
Conclusions:
The ACC/AHA classification predicts mortality at 1 year but not at 30 days for major noncardiac surgeries; procedure-related risk is a better predictor of 30-day postoperative mortality in our patient population.
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