Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery: A Cohort Study
Sasha Mazzarello1, Daniel I McIsaac, W Scott Beattie
1From the School of Epidemiology and Public Health (S.M., D.I.M., D.A.F.) Faculty of Medicine (S.M., D.I.M., D.A.F., M.M.L.) Department of Cellular and Molecular Medicine (M.M.L.), University of Ottawa, Ottawa, Canada the Clinical Epidemiology Program (S.M., D.I.M., D.A.F., M.M.L.) Blueprint Translational Research Group (S.M., D.A.F., M.M.L.) the Regenerative Medicine Program (M.M.L.), Ottawa Hospital Research Institute, Ottawa, Canada the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital (D.I.M., M.M.L.), University of Ottawa, Ottawa, Canada the R. Fraser Elliot Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management University Health Network, Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada (W.S.B.).
Background:
Compared to other perioperative complications, failure to rescue (i.e., death after suffering a complication) is highest after perioperative myocardial infarction (a myocardial infarction that occurs intraoperatively or within 30 days after surgery). The purpose of this study was to identify patient and surgical risk factors for failure to rescue in patients who have had a perioperative myocardial infarction.
Methods:
Individuals who experienced a perioperative myocardial infarction after noncardiac surgery between 2012 and 2016 were identified from the American College of Surgeons (Chicago, Illinois) National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue. Subgroup and sensitivity analyses evaluated the robustness of primary findings.
Results:
The authors identified 1,307,884 individuals who had intermediate to high-risk noncardiac surgery. A total of 8,923 (0.68%) individuals had a perioperative myocardial infarction, of which 1,726 (19.3%) experienced failure to rescue. Strongest associations (adjusted odds ratio greater than 1.5) were age 85 yr or older (2.52 [95% CI, 2.05 to 3.09] vs. age younger than 65 yr), underweight body mass index (1.53 [95% CI, 1.17 to 2.01] vs. normal body mass index), American Society of Anesthesiologists class IV (1.76 [95% CI, 1.33 to 2.31] vs. class I or II) and class V (3.48 [95% CI, 2.20 to 5.48] vs. class I or II), and presence of: ascites (1.81 [95% CI, 1.15 to 2.87]), disseminated cancer (1.54 [95% CI, 1.18 to 2.00]), systemic inflammatory response syndrome (1.55 [95% CI, 1.26 to 1.90]), sepsis (1.75 [95% CI, 1.39 to 2.20]), septic shock (1.79 [95% CI, 1.34 to 2.37]), and dyspnea at rest (1.94 [95% CI, 1.32 to 2.86]). Patients who had emergency surgery, high-risk procedures, and postoperative complications were at higher risk of failure to rescue.
Conclusions:
Routinely identified patient and surgical factors predict risk of failure to rescue after perioperative myocardial infarction.
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