Faculty Collaboration Database

Surgical Apgar score is associated with myocardial injury after noncardiac surgery. J Clin Anesth 2016 Nov;34:395-402

Date

10/01/2016

Pubmed ID

27687420

DOI

10.1016/j.jclinane.2016.05.009

Scopus ID

2-s2.0-84973321100 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

STUDY OBJECTIVE: To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery.

DESIGN: Single-center retrospective cohort study of surgical patients from 2007 to 2012.

SETTING: Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center.

PATIENTS: A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available.

MEASUREMENTS: The 10-point Surgical Apgar Score (SAS) was calculated from intraoperative heart rate, blood pressure, and blood loss. Peak troponin (cTn) levels, hospital length of stay, 7- and 30-day postoperative mortality, patient demographics, and prior medical conditions were gathered. Troponin leak was defined as cTn-I 0.6 to 1.5 ng/mL or cTn-T 0.1 to 0.3 ng/mL; perioperative MI criteria were cTn-I greater than 1.5 ng/mL or cTn-T greater than 0.30 ng/mL.

MAIN RESULTS: Of 46,799 noncardiac surgical cases, 209 (0.4%) and 192 (0.4%) suffered cTn leak and MI, respectively. Low SAS (0-4) was associated with increased risk of cTn leak and perioperative MI (univariate odds ratio, 2.76 and 2.06; 95% confidence interval, 2.20-3.45 and 1.57-2.70, respectively). In multivariable analysis, Surgical Apgar Score, age 65 years or older, American Society of Anesthesiologists physical status greater than or equal to III, emergency surgery, history of MI or hypertension, prolonged intraoperative tachycardia (heart rate >100 beats/min for >59 minutes), and prolonged hypotension (mean arterial pressure <40 mm Hg for >2 minutes) were independently associated with cTn leak and perioperative MI.

CONCLUSIONS: Low SAS scores (0-4) may be associated with cTn elevation after noncardiac surgery. SAS-based risk stratification may guide perioperative cTn surveillance in lieu of routine postoperative screening.

Author List

House LM, Marolen KN, St Jacques PJ, McEvoy MD, Ehrenfeld JM

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Hemodynamics
Humans
Hypotension
Male
Middle Aged
Monitoring, Intraoperative
Myocardial Infarction
Myocardial Ischemia
Postoperative Complications
Postoperative Period
Retrospective Studies
Risk Assessment
Surgical Procedures, Operative
Tennessee
Troponin I
Troponin T