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Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients
Gregory A Nuttall1, Michael P Merren1, Julian Naranjo1
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Insights
Major adverse cardiac events (MACE) are not the primary cause of death after noncardiac surgery. Sepsis and malignancy are leading causes of mortality within 30 days post-surgery.
Area of Science:
- Cardiology
- Surgical Outcomes
- Critical Care Medicine
Background:
- Major adverse cardiac events (MACE) are a significant concern following noncardiac surgery.
- Understanding the contemporary causes of mortality after noncardiac surgery is crucial for risk stratification and management.
Purpose of the Study:
- To determine if major adverse cardiac events (MACE) remain a primary driver of mortality after noncardiac surgery.
- To identify the leading causes of death within 30 days following noncardiac surgical procedures.
Main Methods:
- Retrospective analysis of 75,410 adult patients undergoing noncardiac surgery at Mayo Clinic Rochester from January 1, 2016, to May 4, 2018.
- Review of electronic medical records to collect data on all deaths occurring within 30 days of surgery.
- Calculation of the incidence of death due to MACE and other causes.
Main Results:
- Postoperative MACE occurred in 150 patients (21.4 per 10,000), with most events happening within 3 days of surgery.
- Leading causes of 30-day postoperative death were sepsis (28%), malignancy (27%), cardiovascular disease (12%), and neurologic disease (12%).
- Intraoperative deaths were primarily due to exsanguination (75%) and cardiac arrest (25%).
Conclusions:
- Major adverse cardiac events (MACE) were not the leading cause of intraoperative or postoperative mortality.
- Sepsis and malignancy represent the most significant contributors to 30-day mortality after noncardiac surgery.
Objective:
To evaluate whether major adverse cardiac events (MACE) continue to be a major causative factor for mortality after noncardiac surgery.
Patients And Methods:
We performed retrospective study of 75,410 adult noncardiac surgery patients at Mayo Clinic Rochester, between January 1, 2016, and May 4, 2018. Electronic medical records were reviewed and data collected on all deaths within 30 days (n=692 patients) of surgery. The incidence of death due to MACE was calculated.
Results:
Postoperative MACE occurred in 150 patients (21.4 events per 10,000 patients; 95% CI, 18.2-25.2 events per 10,000 patients) with most occurring within 3 days of surgery (n=113). Postoperative MACE events were associated with atrial fibrillation with rapid rate response in 25 patients (16.7%), sepsis in 15 patients (10%), and bleeding in 15 patients (10%). There were 12 intraoperative deaths of which 9 were due to exsanguination (75%) and the remaining 3 (25%) due to cardiac arrest. Of the 56 deaths on the first 24 hours after surgery, 7 were due to hemorrhage, 17 due to cardiovascular causes, 20 due to sepsis, and 7 due to neurologic disease. The leading cause of total death over 30 days postoperatively was sepsis (28%), followed by malignancy (27%), cardiovascular disease (12%) neurologic disease (12%), and hemorrhage (5%).
Conclusion:
MACE was not the leading cause of death both intraoperatively and postoperatively.
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