Microvascular Disease and Perioperative Outcomes of Non-Cardiac Surgery

Contemporary approaches to cardiovascular risk stratification before noncardiac surgery focus on macrovascular atherosclerotic disease and risk factors. We sought to determine the prevalence of microvascular disease (MVD) and its associated perioperative outcomes. Adults ≥18 years old undergoing noncardiac surgery between 2004 and 2014 were identified using the Nationwide Inpatient Sample (NIS). Prevalent MVD (retinopathy, neuropathy, and nephropathy) was identified by ICD-9 diagnosis codes. The primary outcomes were all-cause in-hospital mortality and the composite of major adverse cardiac events (MACE; death, myocardial infarction, and ischemic stroke). Multivariable logistic regression models were used to estimate associations between MVD and outcomes after adjusting for demographics and clinical covariates. Among 81,297,003 hospitalizations for noncardiac surgery, 4,236,932 (5.0%) had a diagnosis of MVD. Patients with MVD were older and more likely to have traditional cardiovascular risk factors. In-hospital perioperative MACE (4.1% vs. 1.9%; adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI] 1.13 to 1.17) and mortality (2.0% vs. 1.1%; aOR 1.15, 95% CI 1.12 to 1.17) were greater in hospitalizations with MVD compared with those without. Microvascular disease was associated with postoperative outcomes in when stratified by age, sex, and coronary artery disease (CAD). Compared with surgical hospitalizations without CAD or MVD, MVD alone (aOR 1.12; 95% CI 1.11 to 1.14), CAD alone (aOR 1.44; 95% CI 1.42 to 1.46), and MVD with CAD (aOR 2.01; 95% CI 1.96 to 2.06) were associated with perioperative MACE. In conclusion, microvascular disease was present in 1 in 20 hospitalizations for noncardiac surgery, and was associated with perioperative mortality and MACE independent of macrovascular disease and traditional risk factors.