Lerman et al identified risk factors associated with 90-day mortality following non-cardiac surgery in a patient with heart failure. The authors are from Stanford University, University of California Los Angeles and the Palo Alto Veterans Affairs Health Care System.
Patient selection: heart failure undergoing noncardiac surgery
Parameters contributing most to the explained mortality variance (percent contribution to gap from 12.53 to 20.75):
(1) higher ASA class (from ASA 2 to 5; heart failure precludes ASA 1)
(2) age in years
(3) preoperative hematocrit (with anemia)
Other parameters which contributed less (percent contribution to gap from 1.79 to 2.79):
(1) COPD
(2) coronary artery disease
(3) disseminated cancer
(4) chronic kidney disease
(5) history of stroke
These could be captured with ASA 3 or 4.
Optimizing comorbid conditions and trying to correct anemia are strategies that can reduce risk.
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