Adverse outcomes after surgery after a cerebrovascular accident or acute coronary syndrome: a retrospective observational cohort study.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2024-10-08 DOI:10.1016/j.bja.2024.08.029

Matthew S Luney, Christos V Chalitsios, William Lindsay, Robert D Sanders, Tricia M McKeever, Iain K Moppett

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Abstract

Background: Delaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied.

Methods: This was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing noncardiac, non-neurologic surgery in 2007-2018 were included. The time interval between a preoperative cardiovascular event and surgery was the main exposure. The outcomes of interest were acute coronary syndrome (ACS), acute myocardial infarction (AMI), cerebrovascular accident (CVA) within 1 year of surgery, unplanned readmission (at 30 days and 1 year), and prolonged length of stay. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios (aORs; age, sex, socioeconomic deprivation, and comorbidities).

Results: In total, 877 430 people had a previous cardiovascular event and 20 582 717 were without an event. CVA, ACS, and AMI in the year after elective surgery were more frequent after prior cardiovascular events (adjusted hazard ratio 2.12, 95% confidence interval [CI] 2.08-2.16). Prolonged hospital stay (aOR 1.36, 95% CI 1.35-1.38) and 30-day (aOR 1.28, 95% CI 1.25-1.30) and 1-yr (aOR 1.60, 95% CI 1.58-1.62) unplanned readmission were more common after major operations in those with a prior cardiovascular event. After adjusting for the time interval between preoperative events until surgery, elective operations within 37 months were associated with an increased risk of postoperative ACS or AMI. The risk of postoperative stroke plateaued after a 20-month interval until surgery, irrespective of surgical urgency.

Conclusions: These observational data suggest increased adverse outcomes after a recent cardiovascular event can occur for up to 37 months after a major cardiovascular event.

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脑血管意外或急性冠状动脉综合征术后的不良后果：一项回顾性观察队列研究。

背景：发生重大心血管事件后推迟手术可减少术后不良后果。时间间隔是一个潜在的可改变的风险因素，但相关研究并不充分：这是一项基于人群的纵向回顾性队列研究，将英国国家医疗服务系统（NHS）的医院事件统计和心肌缺血国家审计项目的数据联系起来。研究纳入了 2007-2018 年间接受非心脏、非神经系统手术的成年人。术前心血管事件与手术之间的时间间隔是主要暴露因素。关注的结果包括术后一年内的急性冠状动脉综合征（ACS）、急性心肌梗死（AMI）、脑血管意外（CVA）、非计划再入院（30 天和 1 年）以及住院时间延长。使用限制性三次样条的多变量逻辑回归模型来估计调整后的几率比（aORs；年龄、性别、社会经济贫困程度和合并症）：共有 877 430 人曾发生过心血管事件，20 582 717 人未发生过心血管事件。既往发生过心血管事件的患者在择期手术后一年内发生 CVA、ACS 和 AMI 的频率更高（调整后危险比为 2.12，95% 置信区间 [CI] 为 2.08-2.16）。曾发生过心血管事件的患者在大手术后更容易出现住院时间延长（aOR 1.36，95% CI 1.35-1.38）、30 天（aOR 1.28，95% CI 1.25-1.30）和 1 年（aOR 1.60，95% CI 1.58-1.62）非计划再入院的情况。调整术前事件到手术之间的时间间隔后，37 个月内的择期手术与术后 ACS 或 AMI 风险增加有关。无论手术的紧迫性如何，术后中风的风险在间隔 20 个月后趋于稳定：这些观察性数据表明，近期心血管事件后不良后果的增加可能发生在重大心血管事件后的 37 个月内。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.