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Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices. 左心室辅助装置患者非心脏手术的麻醉管理。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-04-01 Epub Date: 2023-03-10 DOI: 10.4097/kja.23169
Jeong-Jin Min, Yang Hyun Cho, Sangmin M Lee, Jong-Hwan Lee

With the growing number of patients undergoing left ventricular assist device (LVAD) implantation and improved survival in this population, more patients with LVADs are presenting for various types of non-cardiac surgery. Therefore, anesthesiologists need to understand the physiology and adequately prepare for the perioperative management of this unique patient population. This review addresses perioperative considerations and intraoperative management for the safe and successful management of patients with an LVAD undergoing non-cardiac surgery. Understanding the basic physiology of preload dependency and afterload sensitivity in these patients is essential. The main considerations include a collaborative preoperative multidisciplinary approach, perioperative care aimed at optimizing the intravascular volume and right ventricular function, and maintaining the afterload within recommended ranges for optimal LVAD function.

随着接受左心室辅助装置(LVAD)植入术的患者人数不断增加以及该人群存活率的提高,越来越多的左心室辅助装置患者开始接受各种类型的非心脏手术。因此,麻醉医生需要了解这一特殊患者群体的生理情况,并为围术期管理做好充分准备。本综述将讨论围术期注意事项和术中管理,以便安全、成功地管理接受非心脏手术的 LVAD 患者。了解这些患者前负荷依赖性和后负荷敏感性的基本生理学至关重要。主要考虑因素包括术前多学科协作方法、旨在优化血管内容量和右心室功能的围手术期护理,以及将后负荷维持在建议范围内以实现 LVAD 的最佳功能。
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引用次数: 0
Association of the perfusion index with postoperative acute kidney injury: a retrospective study. 灌注指数与术后急性肾损伤的关系:一项回顾性研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-04-01 Epub Date: 2024-03-29 DOI: 10.4097/kja.22620.e1
Pyoyoon Kang, Jung-Bin Park, Hyun-Kyu Yoon, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Hyung Chul Lee, Jin-Tae Kim, Hee-Soo Kim
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引用次数: 0
Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis. 超滤对心脏手术心肺旁路期间全血凝血功能的影响:回顾性分析
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-04-01 Epub Date: 2024-01-30 DOI: 10.4097/kja.23698
Jaemoon Lee, Dong-Kyu Lee, Won-Kyoung Kwon, Sookyung Lee, Chung-Sik Oh, Klaus Görlinger, Tae-Yop Kim

Background: Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery.

Methods: We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients.

Results: The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P < 0.001), and its cut-off value was 50.5 mm (specificity of 81.8% and sensitivity of 84.2% in Youden's J statistic). In the secondary analyses using the cut-off value, UF significantly increased the median MCF-EXTEM from 40.5 mm to 42.5 mm in 18 patients with pre-UF MCF-EXTEM ≤ 50.5 mm. However, it did not increase MCF-EXTEM in 12 patients with pre-UF MCF-EXTEM > 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction).

Conclusions: Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB.

背景:超滤(UF)可在心脏手术心肺旁路(CPB)期间浓缩凝血因子,从而改善凝血状况:我们回顾性审查了一家大学医院 75 名接受心脏手术的患者的电子病历,这些患者接受了基于旋转血栓弹性测定的凝血管理,并分析了 30 名患者在 CPB 期间超滤引起的组织因子外激活试验(EXTEM)最大凝块坚固度(MCF)的变化:结果:无滤过水的中位体积为 1350 毫升,中位血细胞比容从 22.5% 显著升至 25.5%。作为主要测量指标,UF 使中位 MCF-EXTEM 从 48.0 mm 显著增加到 50.5 mm(P = 0.015,效应大小 r = 0.44)。应用 UF 前 MCF-EXTEM 的接收器操作特征曲线下面积为 0.89(95% CI:0.77-1.00,P <0.001),用于判别应用 UF 后 MCF-EXTEM 的任何增加,其临界值为 50.5 mm(Youden's J 统计的特异性为 81.8%,灵敏度为 84.2%)。在使用临界值进行的二次分析中,在18例UF前MCF-EXTEM≤50.5毫米的患者中,UF可使中位MCF-EXTEM从40.5毫米显著增加到42.5毫米。然而,在 12 例超导前 MCF-EXTEM > 50.5 mm 的患者中,MCF-EXTEM 没有增加。UF前的MCF-EXTEM值与应用UF之间存在明显的交互作用(亚组的P < 0.001,UF的P = 0.046,交互作用的P = 0.003):结论:应用 UF 可改善血凝块的坚固性,当 CPB 期间降低 UF 前 MCF-EXTEM 值时,改善效果更明显。
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引用次数: 0
Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report. 食管镜检查中经计算机断层肺血管造影证实的静脉空气栓塞1例。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-04-01 Epub Date: 2023-11-29 DOI: 10.4097/kja.23722
Thadakorn Tantisarasart, Thara Tantichamnankul, Chanatthee Kitsiripant, Panjai Choochuen

Background: Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA).

Case: A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient's oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4.

Conclusions: Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.

背景:食管胃十二指肠镜检查(EGD)对各种胃肠道疾病的诊断和治疗至关重要,但其静脉空气栓塞(VAE)的风险较低。我们报告一例在EGD期间的VAE,经计算机断层肺血管造影(CTPA)证实。病例:56岁男性,有下咽癌病史,因吞咽困难相关食管扩张行EGD。注意到VAE的迹象,促使迅速干预,包括氧气治疗,体位改变和CTPA。CTPA显示梅赛德斯-奔驰标志,纵隔气肿,轻微气胸。患者行CTPA前30 min血氧饱和度改善,术后第4天出院。结论:及时认识到VAE,并在CTPA的支持下采取适当的干预措施,可获得良好的患者预后。
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引用次数: 0
Association of preoperative blood glucose level with delirium after non-cardiac surgery in diabetic patients. 糖尿病患者术前血糖水平与非心脏手术后谵妄的关系。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-04-01 Epub Date: 2024-01-04 DOI: 10.4097/kja.23301
Soo Jung Park, Ah Ran Oh, Jong-Hwan Lee, Kwangmo Yang, Jungchan Park

Background: Hyperglycemia has shown a negative association with cognitive dysfunction. We analyzed patients with high preoperative blood glucose level and hemoglobin A1c (HbA1c) level to determine the prevalence of postoperative delirium.

Methods: We reviewed a database of 23,532 patients with diabetes who underwent non-cardiac surgery. Acute hyperglycemia was defined as fasting blood glucose > 140 mg/dl or random glucose > 180 mg/dl within 24 h before surgery. Chronic hyperglycemia was defined as HbA1c level above 6.5% within three months before surgery. The incidence of delirium was compared according to the presence of acute and chronic hyperglycemia.

Results: Of the 23,532 diabetic patients, 21,585 had available preoperative blood glucose level within 24 h before surgery, and 18,452 patients reported levels indicating acute hyperglycemia. Of the 8,927 patients with available HbA1c level within three months before surgery, 5,522 had levels indicating chronic hyperglycemia. After adjustment with inverse probability weighting, acute hyperglycemia was related to higher incidence of delirium (hazard ratio: 1.33, 95% CI [1.10,1.62], P = 0.004 for delirium) compared with controls without acute hyperglycemia. On the other hand, chronic hyperglycemia did not correlate with postoperative delirium.

Conclusions: Preoperative acute hyperglycemia was associated with postoperative delirium, whereas chronic hyperglycemia was not significantly associated with postoperative delirium. Irrespective of chronic hyperglycemia, acute glycemic control in surgical patients could be crucial for preventing postoperative delirium.

背景:高血糖与认知功能障碍呈负相关。我们对术前血糖水平和血红蛋白 A1c(HbA1c)水平较高的患者进行了分析,以确定术后谵妄的发生率:我们回顾了一个包含 23,532 名接受非心脏手术的糖尿病患者的数据库。急性高血糖定义为手术前 24 小时内空腹血糖 > 140 mg/dl 或随机血糖 > 180 mg/dl。慢性高血糖定义为手术前三个月内 HbA1c 水平超过 6.5%。根据急性和慢性高血糖的存在情况,比较了谵妄的发生率:在 23,532 名糖尿病患者中,21,585 名患者在术前 24 小时内有术前血糖水平,18,452 名患者报告的血糖水平显示为急性高血糖。在 8,927 名有术前三个月 HbA1c 水平的患者中,5,522 名患者的血糖水平显示为慢性高血糖。经反概率加权(IPW)调整后,与无急性高血糖的对照组相比,急性高血糖与较高的谵妄发生率有关(危险比 [HR] = 1.33,95% CI 1.10-1.62,P = 0.004)。另一方面,慢性高血糖与术后谵妄无关:结论:术前急性高血糖与术后谵妄有关,而慢性高血糖与术后谵妄无明显关系。无论是否存在慢性高血糖,手术患者的急性血糖控制都是预防术后谵妄的关键。
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引用次数: 0
Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial. 局部麻醉剂量(20 毫升与 40 毫升)对肩关节镜手术中肋锁关节阻滞镇痛效果的影响:随机对照试验。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-02-01 Epub Date: 2023-09-08 DOI: 10.4097/kja.23260
Yumin Jo, Chahyun Oh, Woo-Yong Lee, Hyung-Jin Chung, Hanmi Park, Juyeon Park, Jieun Lee, Yoon-Hee Kim, Youngkwon Ko, Woosuk Chung, Boohwi Hong

Background: Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading.

Methods: Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively.

Results: The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [-13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups.

Conclusions: Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.

背景:在椎间孔阻滞的各种膈肌保留替代方法中,肋锁阻滞(CCB)在肩关节镜手术中显示出较低的半膈肌麻痹(HDP)发生率,但镇痛效果却不一致。我们假设,在 CCB 中使用较大剂量的局麻药可通过实现充分的锁骨上扩散来提供足够的镇痛效果:60名计划接受关节镜肩袖修复术的患者被随机分配到使用两种容量局麻药中的一种接受CCB治疗(CCB20,0.75%罗哌卡因20毫升;CCB40,0.375%罗哌卡因40毫升)。主要结果是术后 1 小时完全镇痛率(疼痛数字评分表为 0)。次要结果包括对局部麻醉剂扩散、膈肌功能、肺功能、术后阿片类药物的使用以及术后 24 小时内其他与疼痛相关的经历进行声学评估:完全镇痛率无显著差异(CCB20 组和 CCB40 组的完全镇痛率分别为 23.3% [7/30] 和 33.3% [10/30];风险差异为 10%,95% CI [-13, 32],P = 0.567)。其他疼痛相关结果无明显差异。在考虑的临床因素中,唯一与术后疼痛显著相关的因素是声像图观察到的锁骨上蔓延。两组患者的HDP发生率和肺功能变化无明显差异:结论:使用 40 毫升局麻药并不能保证 CCB 时锁骨上蔓延。结论:在肩关节镜手术中使用 40 毫升局麻药并不能保证锁骨上扩散,而且与使用 20 毫升局麻药相比,完全镇痛率也不高。
{"title":"Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial.","authors":"Yumin Jo, Chahyun Oh, Woo-Yong Lee, Hyung-Jin Chung, Hanmi Park, Juyeon Park, Jieun Lee, Yoon-Hee Kim, Youngkwon Ko, Woosuk Chung, Boohwi Hong","doi":"10.4097/kja.23260","DOIUrl":"10.4097/kja.23260","url":null,"abstract":"<p><strong>Background: </strong>Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading.</p><p><strong>Methods: </strong>Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively.</p><p><strong>Results: </strong>The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [-13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups.</p><p><strong>Conclusions: </strong>Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"85-94"},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10553328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on "The novel diagonal suprascapular canal block for shoulder surgery analgesia: a comprehensive technical report". 评论:“新型肩胛上斜管阻滞用于肩部手术镇痛”。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-02-01 Epub Date: 2023-10-18 DOI: 10.4097/kja.23677
Raghuraman M Sethuraman
{"title":"Comment on \"The novel diagonal suprascapular canal block for shoulder surgery analgesia: a comprehensive technical report\".","authors":"Raghuraman M Sethuraman","doi":"10.4097/kja.23677","DOIUrl":"10.4097/kja.23677","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"168-169"},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49679105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Han scale and difficult facemask ventilation: time to add an "R"? 汉标和困难口罩通风:该加个“R”了吗?
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-02-01 Epub Date: 2023-11-21 DOI: 10.4097/kja.23493
David Lopez-Lopez, Adrian Garcia-Romar, Patricia Neira-Somoza, Pablo Casas-Reza, Rocio Mato-Bua
{"title":"Han scale and difficult facemask ventilation: time to add an \"R\"?","authors":"David Lopez-Lopez, Adrian Garcia-Romar, Patricia Neira-Somoza, Pablo Casas-Reza, Rocio Mato-Bua","doi":"10.4097/kja.23493","DOIUrl":"10.4097/kja.23493","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"165-166"},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138176565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study. 超声引导下骶骨竖肌脊柱平面阻滞正中入路和中间入路的比较:一项尸体和放射学研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-02-01 Epub Date: 2023-11-15 DOI: 10.4097/kja.23604
Bilge Olgun Keleş, Necati Salman, Elvan Tekir Yılmaz, Habip Resul Birinci, Alparslan Apan, Selami İnce, Ali Faruk Özyaşar, Aysun Uz

Background: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB.

Methods: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution.

Results: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels.

Conclusions: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

背景:直立脊柱平面阻滞(ESPB)是一种成熟的治疗术后和慢性疼痛的方法。应用于骶骨部位手术的ESPB称为骶骨ESPB (sespb)。本尸体研究旨在确定采用中位和中间入路进入SESPB的局部麻醉分布。方法:将4具尸体分为中位入路组和中间入路组。超声引导的sespb使用不透射线剂和染料的混合物进行。通过计算机断层扫描(CT)确认溶液分布后,解剖尸体观察溶液分布。结果:正中组CT图像显示S1和S5水平面之间的透射线溶液皮下池化。不透射线的溶液也从骶孔通过S2和S5之间的脊神经进入骶骨前。在中间组,溶液沿双侧竖脊肌L2和S3水平面之间分布;未见前移。正中组解剖发现S1和S5水平面之间的皮下组织有蓝色溶液分布,浅筋膜和肌肉无分布。在中间组,在L2和S3椎间水平之间的竖脊肌中检测到红色溶液。结论:放射学和解剖学结果显示,在中位组和中间组的浅表和竖脊间室都存在不透射线的染料。然而,仅在正中组检测到不透射线染料的前移。
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引用次数: 0
Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study. 非心脏手术后围手术期不良心脏事件和死亡率:一项多中心研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-02-01 Epub Date: 2023-05-10 DOI: 10.4097/kja.23043
Byungjin Choi, Ah Ran Oh, Jungchan Park, Jong-Hwan Lee, Kwangmo Yang, Dong Yun Lee, Sang Youl Rhee, Sang-Soo Kang, Seung Do Lee, Sun Hack Lee, Chang Won Jeong, Bumhee Park, Soobeen Seol, Rae Woong Park, Seunghwa Lee

Background: Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records.

Methods: Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis.

Results: After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk).

Conclusions: A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.

背景介绍围手术期不良心脏事件(PACE)是术后 30 天内心肌梗死、冠状动脉血运重建、充血性心力衰竭、心律失常发作、急性肺栓塞、心脏骤停和中风的综合征,与长期死亡率相关,但临床证据有限。我们利用全国多中心电子病历数据比较了 PACE 与长期死亡率:方法:我们使用了 7 家医院的数据,并将其转换为观察性医疗结果合作组织通用数据模型。我们提取了 277,787 名 18 岁以上首次在医院接受非心脏手术的成年患者的记录,这些患者在手术前有超过 180 天的医疗记录。我们进行了倾向得分匹配,然后进行了汇总荟萃分析:经过 1:4 倾向评分匹配后,7970 名患者获得了 PACE,28807 名患者未获得 PACE。荟萃分析表明,PACE 与较高的一年期死亡率风险(危险比 [HR]:1.33,95% CI [1.10,1.60],P = 0.005)和较高的三年期死亡率(HR:1.18,95% CI [1.01,1.38],P = 0.038)相关。在亚组分析中,风险较高的外科手术的PACE一年死亡率风险更高(低风险手术的HR:1.20,95% CI [1.04,1.39],P = 0.020;中风险手术的HR:1.69,95% CI [1.45,1.96],P < 0.001;高风险手术的HR:2.38,95% CI [1.47,3.86],P = 0.034):一项全国范围的多中心研究表明,PACE 与一年死亡率的增加有显著相关性。在高风险手术、老年人、男性和慢性肾病亚组中,这种关联性更强。需要进一步研究以改善与 PACE 相关的死亡率。
{"title":"Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study.","authors":"Byungjin Choi, Ah Ran Oh, Jungchan Park, Jong-Hwan Lee, Kwangmo Yang, Dong Yun Lee, Sang Youl Rhee, Sang-Soo Kang, Seung Do Lee, Sun Hack Lee, Chang Won Jeong, Bumhee Park, Soobeen Seol, Rae Woong Park, Seunghwa Lee","doi":"10.4097/kja.23043","DOIUrl":"10.4097/kja.23043","url":null,"abstract":"<p><strong>Background: </strong>Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records.</p><p><strong>Methods: </strong>Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis.</p><p><strong>Results: </strong>After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk).</p><p><strong>Conclusions: </strong>A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"66-76"},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9501406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Korean Journal of Anesthesiology
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