Pedersen et al developed a model for predicting the risk of cardiovascular complications after anesthesia and non cardiac surgery. This can help identify patients who may require closer monitoring and more aggressive management in the perioperative period. The authors are from the University of Copenhagen in Denmark.
Cardiovascular complications:
(1) abnormal blood pressure (severe hypotension or hypertension)
(2) cardiac arrest
(3) ECG changes (heart block, second or third degree AV block, bundle branch block, ventricular tachycardia or fibrillation, supraventricular tachycardia, severe bradycardia)
(4) angina
(5) myocardial infarction
(6) heart failure
(7) pulmonary embolism
Major surgery included:
(1) open cholecystectomy
(2) perforated peptic ulcer with vagotomy and pyloroplasty
(3) gastrojejunostomy
(4) removal of adhesions in intestinal obstruction
(5) partial or total colectomy
(6) colostomy
(7) explorative laparotomy
(8) caesarean section
(9) thyroidectomy
(10) organ transplantation
(11) renal graftectomy
(12) open reduction and internal fixation of a major fracture
(13) major bone surgery
Parameters affecting risk:
(1) chronic heart failure
(2) preoperative renal failure (serum creatinine > 300 µmol/L, > 3.39 mg/dL)
(3) ischemic heart disease
(4) previous myocardial infarction (AMI)
(5) age
(6) major surgery
|
Parameter
|
Finding
|
Points
|
|
chronic heart failure
|
absent
|
0
|
|
|
present
|
1.83
|
|
preoperative renal failure
|
absent
|
0
|
|
|
present
|
0.85
|
|
ischemic heart disease
|
absent
|
0
|
|
|
present
|
1.00
|
|
previous AMI
|
none
|
0
|
|
|
>= 1 year ago
|
1.65
|
|
|
< 1 year
|
1.33
|
|
age of the patient
|
< 50 years
|
0
|
|
|
50 - 69 years
|
1.26
|
|
|
>= 70 years
|
1.96
|
|
major surgery
|
no
|
0
|
|
|
yes
|
1.36
|
where:
• The points are the coefficients for the logistic regression model.
X =
= SUM(points for all 6 factors) - 5.98
probability of cardiovascular complication =
= EXP(X) / (1 + EXP(X))
