Clinical research studyPerioperative cardiovascular mortality in noncardiac surgery: Validation of the Lee cardiac risk index
Section snippets
Hospital setting, procedures and patients
The Erasmus Medical Center, a metropolitan university hospital that serves a population of approximately 3 million people in the southwestern area of The Netherlands, acts as a tertiary referral center for approximately 30 affiliated hospitals. Between January 1, 1991, and December 31, 2000, 122 860 noncardiac surgical procedures were performed in patients above the age of 15 years in the Erasmus Medical Center. We excluded 14 267 planned and unplanned procedures that were conducted within 30
Results
A total of 52 387 surgical procedures were performed in men, including 12 378 orthopedic surgeries (24%); 9273 ear, nose, and throat surgeries (18%); and 8637 abdominal surgeries (16%). Among the 56 206 procedures in women, gynecological surgery was most common with 15 312 procedures (27%), followed by orthopedic surgery with 9840 (18%), and abdominal surgery with 7816 (14%). Because of reallocation of patients among regional hospitals, the annual volumes of ophthalmic and gynecological procedures
Discussion
Cardiovascular mortality still is a major burden in patients undergoing noncardiac surgery. In the investigated cohort, about 7 of every 1000 procedures in men and 3 of every 1000 procedures in women resulted in fatal in-hospital cardiovascular complications. In contrast, anesthesia-related mortality occurs only in approximately 1 of 250 000 procedures.16 Interestingly, patients who underwent postmortem examination were considerably more often classified as cardiovascular death than were
Conclusion
This single center study, which involved over 100 000 subjects, demonstrated that perioperative cardiovascular mortality is a major burden in patients undergoing noncardiac surgery. Little progress has been achieved in reducing cardiovascular mortality during the years of the study. The adapted Lee index had an admirable performance to predict cardiovascular mortality, but its simple classification of procedures as high risk versus not high risk seems suboptimal. Our analysis is limited by the
References (27)
- et al.
Pathology of fatal perioperative myocardial infarctionimplications regarding pathophysiology and prevention
Int J Cardiol
(1996) - et al.
Fluvastatin and bisoprolol for the reduction of perioperative cardiac mortality and morbidity in high-risk patients undergoing non-cardiac surgeryrationale and design DECREASE-IV study
Am Heart J
(2004) MRC/BHF Heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individualsa randomised placebo controlled trial
Lancet
(2002)- et al.
Multifactorial index of cardiac risk in noncardiac surgical procedures
N Engl J Med
(1997) Assessing cardiac risk in patients who undergo noncardiac surgical procedures
Can J Surg
(1984)- et al.
Prediction of cardiac risk in non-cardiac surgery
Eur Heart J
(1987) - et al.
The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery
Ann Intern Med
(1993) - et al.
Predicting cardiac complications in patients undergoing non-cardiac surgery
J Gen Intern Med
(1986) - et al.
Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery
Circulation
(1999) - et al.
Preoperative assessment of patients with known or suspected coronary disease
N Engl J Med
(1995)