TY - JOUR
T1 - Long-term prognosis after peri-operative cardiac complications
AU - Charlson, Mary
AU - Peterson, Janey
AU - Szatrowski, Ted P.
AU - MacKenzie, Ronald
AU - Gold, Jeffrey
N1 - Funding Information:
Acknowledgements--Supported by a grant from the National Heart, Lung and Blood Institute, R23HL27613, in part by the Robert Wood Johnson Foundation Program to Improve Patient Functional Status, by the Arthritis and Musculoskeletal Disease Center, National Institute of Arthritis and Musculoskeletal Diseases, No. IP60AR385 20-OlAl and by National Heart, Lung and Blood Institute, ROl HL44719-01.
PY - 1994/12
Y1 - 1994/12
N2 - The objective was to document the 5 year prognosis of patients who had cardiac complications after non-cardiac surgery. Design: 5-year follow-up of 218 patients originally enrolled in a prospective study to identify risks factors for perioperative complications. Setting: an academic medical center. Participants were hypertensives and diabetics who underwent elective surgery between 1982 and 1985. In the original study, patients were evaluated pre-operatively, monitored intra-operatively by an independent observer, and followed daily for 7 days post-operatively according to a standard surveillance protocol. Outcomes were judged by assessors blinded to the pre-operative status and intra-operative course. Patients were interviewed at 3 and 5 years post-operatively. Patients with post-operative cardiac complications had significantly higher rates of overall mortality, mortality attributable to cardiac causes (MI, CHF, arrest), and mortality attributable to other cardiovascular causes (stroke, renal failure) than patients without cardiac complications. For example, at 5 years 11% of those patients without post-operative cardiac complications had cardiac deaths, in contrast to 45% of those patients with post-operative cardiac complications. Proportional hazards analysis demonstrated that post-operative cardiac complications remained a significant predictor of cardiac (p < 0.001) and cardiovascular (p < 0.0001) mortality controlling for pre-operative cardiac disease, other non-cardiovascular comorbid diseases, age, sex, diabetes, and pre-operative renal insufficiency or stroke. Similarly, patients with post-operative non-fatal cardiac complications had higher rates of cardiac or cardiovascular events during the 5 year follow-up period. We conclude that post-operative cardiac complications have a significant adverse long-term prognostic impact comparable to the prognostic impact of myocardial infarction, ischemia or congestive failure in the non-operative setting. Understanding these events could be an important factor in identifying patients at high risk for subsequent peri-operative complications.
AB - The objective was to document the 5 year prognosis of patients who had cardiac complications after non-cardiac surgery. Design: 5-year follow-up of 218 patients originally enrolled in a prospective study to identify risks factors for perioperative complications. Setting: an academic medical center. Participants were hypertensives and diabetics who underwent elective surgery between 1982 and 1985. In the original study, patients were evaluated pre-operatively, monitored intra-operatively by an independent observer, and followed daily for 7 days post-operatively according to a standard surveillance protocol. Outcomes were judged by assessors blinded to the pre-operative status and intra-operative course. Patients were interviewed at 3 and 5 years post-operatively. Patients with post-operative cardiac complications had significantly higher rates of overall mortality, mortality attributable to cardiac causes (MI, CHF, arrest), and mortality attributable to other cardiovascular causes (stroke, renal failure) than patients without cardiac complications. For example, at 5 years 11% of those patients without post-operative cardiac complications had cardiac deaths, in contrast to 45% of those patients with post-operative cardiac complications. Proportional hazards analysis demonstrated that post-operative cardiac complications remained a significant predictor of cardiac (p < 0.001) and cardiovascular (p < 0.0001) mortality controlling for pre-operative cardiac disease, other non-cardiovascular comorbid diseases, age, sex, diabetes, and pre-operative renal insufficiency or stroke. Similarly, patients with post-operative non-fatal cardiac complications had higher rates of cardiac or cardiovascular events during the 5 year follow-up period. We conclude that post-operative cardiac complications have a significant adverse long-term prognostic impact comparable to the prognostic impact of myocardial infarction, ischemia or congestive failure in the non-operative setting. Understanding these events could be an important factor in identifying patients at high risk for subsequent peri-operative complications.
KW - Cardiac mortality
KW - Cardiovascular mortality
KW - Peri-operative complications
KW - Prognosis
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U2 - 10.1016/0895-4356(94)90083-3
DO - 10.1016/0895-4356(94)90083-3
M3 - Article
C2 - 7730848
AN - SCOPUS:0028594007
SN - 0895-4356
VL - 47
SP - 1389
EP - 1400
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 12
ER -