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Incidence and trends of cardiac complications in major abdominal surgery
Yas Sanaiha1, Yen-Yi Juo1, Esteban Aguayo2
1Division of Cardiac Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
Insights
Higher hospital surgical volume reduces cardiac arrest and mortality after major abdominal surgery, but increases myocardial infarction risk. Further research is needed to improve outcomes for these cardiovascular complications.
Area of Science:
- Surgery
- Cardiology
- Health Services Research
Background:
- Cardiovascular complications are a leading cause of death post-noncardiac surgery.
- Major abdominal operations carry a significant risk of cardiovascular complications.
Purpose of the Study:
- To examine trends in mortality, myocardial infarction, and cardiac arrest after major abdominal surgery.
- To determine the relationship between hospital operative volume and these adverse outcomes.
Main Methods:
- Retrospective analysis of the Nationwide Inpatient Sample (2008-2014).
- Included patients undergoing elective, open abdominal surgeries (esophagectomy, gastrectomy, etc.).
- Univariate and multivariate analyses assessed the impact of operative volume on complication rates.
Main Results:
- 1.4% in-hospital mortality, 0.7% myocardial infarction, 0.35% cardiac arrest observed in 962,754 procedures.
- Myocardial infarction and cardiac arrest increased perioperative mortality risk 24-fold.
- Higher hospital volume correlated with decreased cardiac arrest and mortality, but increased myocardial infarction risk.
- While mortality and myocardial infarction rates decreased, cardiac arrest incidence rose over time.
Conclusions:
- Higher volume centers offer better outcomes for cardiac arrest and mortality post-major abdominal surgery.
- Increased myocardial infarction risk at high-volume hospitals necessitates targeted interventions.
- Further investigation into risk modification and rescue processes at high-volume centers is crucial for quality improvement.
Introduction:
Cardiovascular complications are the leading cause of death after noncardiac surgery. Major abdominal operations represent the largest category of procedures considered to have an increased risk of cardiovascular complications. The current aim was to examine trends in the incidence of mortality, perioperative myocardial infarction, and cardiac arrest to determine the presence of potential volume-outcome relationships.
Methods:
We performed a retrospective analysis of the Nationwide Inpatient Sample for patients undergoing elective, open abdominal esophagectomy, gastrectomy, pancreatectomy, nephrectomy, hepatectomy, splenectomy, and colectomy (major abdominal surgery) during 2008-2014. Univariate and multivariate analyses were performed to determine the impact of operative volume on rates of myocardial infarction, cardiac arrest, and mortality.
Results:
Of the 962,754 elective admissions for major abdominal surgery, 1.4% experienced in-hospital mortality, 0.7% myocardial infarction, and 0.35% cardiac arrest. Myocardial infarction and cardiac arrest were associated with a 24-fold increase in risk of perioperative mortality. Compared with institutions that have a very low volume of operations, those hospitals with larger volumes of operations had a decreased risk of cardiac arrest and incident mortality after cardiovascular complications, but the odds of myocardial infarction were greatest at higher operative-volume hospitals. The annual all-cause mortality and myocardial infarction rates decreased over time, but the incidence of cardiac arrest increased.
Conclusion:
Myocardial infarction or cardiac arrest after major abdominal surgery increased the odds of mortality with superior rescue after cardiovascular complications at higher volume institutions. Across all US hospitals performing major abdominal surgery, the rate of cardiac arrest increased without a concomitant increase in myocardial infarction or mortality. Novel targets for risk modification of myocardial infarction and cardiac arrest as well as investigation of processes that facilitate rescue after these complications at higher operative-volume hospitals are needed to delineate quality improvement opportunities.
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