Worldwide it is estimated that around 200 million people undergo noncardiac surgery annually. Many patients undergoing major noncardiac surgery are at risk for a cardiovascular event.
Now, a study by the European Society of Cardiology revealed the reason behind the death after non-cardiac surgery. The study conducted on more than 40,000 patients from six continents presented in a late-breaking science session at ESC Congress 2018. Myocardial injury, major bleeding, and sepsis contributed to nearly three-quarters of all deaths.
Dr. Jessica Spence, of the Population Health Research Institute (PHRI) said, “There’s a false assumption among patients that once you’ve undergone surgery, you’ve ‘made it’. Unfortunately, that’s not always the case, and now we have a much better sense of when and why people die after noncardiac surgery. Most deaths are linked to cardiovascular causes.”
Almost 715 patients died within 30 days after noncardiac surgery. Of those, 505 (71%) died in hospital (including four [0.6%] in the operating room), and 210 (29%) died after discharge from the hospital. One in 56 patients died within 30 days of noncardiac surgery and nearly all deaths occurred after leaving the operating room, with more than a quarter occurring after hospital discharge.
Eight perioperative complexities – including five cardiovascular – were related to death inside 30 days postoperatively. The main three complexities, which contributed to nearly three-quarters of all deaths, were myocardial damage after a noncardiac medical procedure (MINS; 29%), noteworthy dying (25%), and sepsis (20%).
Principal investigator Professor Philip J. Devereaux, director of cardiology at McMaster University said, “We’re letting patients down in postoperative management. The study suggests that most deaths after noncardiac surgery are due to cardiovascular causes, so cardiologists have a major role to play to improve patient safety. This includes conducting blood and imaging tests to identify patients at risk than giving preventive treatment, including medications that prevent abnormal heart rhythms, lower blood pressure and cholesterol, and prevent blood clots.”
Prior discoveries from the VISION study demonstrated that a simple blood test can recognize MINS, empowering clinicians to mediate early and anticipate assist complications. The blood test estimates a protein called high-affectability troponin T which is discharged into the circulation system when damage to the heart happens.
Regarding cardiovascular complications, MINS occurred in 5,191 (13%) patients and independently increased the risk of 30-day mortality by 2.6-fold; major bleeding occurred in 6,238 (16%) patients and increased risk by 2.4-fold; 372 (0.9%) patients had congestive heart failure, which raised risk by 1.6-fold; 152 (0.4%) patients had deep venous thrombosis which raised risk by 2.1-fold; and 132 (0.3%) patients had a stroke, which increased risk by a factor of 1.6.
Regarding noncardiovascular complications associated with 30-day mortality, sepsis occurred in 1,783 (4.5%) patients and independently increased risk by 5.7-fold; infection occurred in 2,171 (5.4%) patients and raised risk by 1.9-fold; and 118 patients (0.3%) had acute kidney injury resulting in new dialysis, which increased risk by 4.7-fold.
Dr. Spence said, “Combined, these discoveries tell us that we need to become more involved in care and monitoring after surgery to ensure that patients at risk have the best chance for a good recovery.”