Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study

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Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity : international prospective cohort study

Lurati Buse, Giovanna A. (författare): Anesthesiology Department University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany

Mauermann, Eckhard (författare): Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland

Ionescu, Daniela (författare): Department of Anaesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

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Szczeklik, Wojciech (författare): Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland

De Hert, Stefan (författare): Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium

Filipovic, Miodrag (författare): Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland

Beck-Schimmer, Beatrice (författare): Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Spadaro, Savino (författare): Department of Translational Medicine, University of Ferrara, Ferrara, Italy

Matute, Purificación (författare): Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain

Bolliger, Daniel (författare): Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland

Turhan, Sanem Cakar (författare): Department of Anesthesiology and ICU, Ankara University Medical School, Ankara, Turkey

van Waes, Judith (författare): Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands

Lagarto, Filipa (författare): Department of Anesthesiology, Hospital Beatriz Angelo, Loures, Portugal

Theodoraki, Kassiani (författare): Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece

Gupta, Anil (författare): Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

Gillmann, Hans-Jörg (författare): Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany

Guzzetti, Luca (författare): Anesthesia and Intensive Care Department, University Hospital, Varese, Italy

Kotfis, Katarzyna (författare): Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland

Wulf, Hinnerk (författare): Department of Anesthesiology and Critical Care Medicine, University Hospital Marburg, Marburg, Germany

Larmann, Jan (författare): Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

Corneci, Dan (författare): Carol Davila University of Medicine and Pharmacy Bucharest Head of Anesthesia and Intensive Care Department I, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

Chammartin-Basnet, Frederique (författare): Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland

Howell, Simon J. (författare): Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK

MET: Reevaluation for Perioperative Cardiac Risk investigators, Jakob (författare)

Walldén, Jakob (bidragsgivare): Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap

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Elsevier, 2023
2023
Engelska.
Ingår i: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771. ; 130:6, s. 655-665

Relaterad länk:: https://urn.kb.se/re...; visa fler...; https://doi.org/10.1...; http://kipublication...; visa färre...

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BACKGROUND: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery.METHODS: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated.RESULTS: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71-0.77], ROC AUCbaseline+4METs 0.74 [0.71-0.77], ROC AUCbaseline+floors climbed 0.75 [0.71-0.78], AUCbaseline+fitnessvspeers 0.74 [0.71-0.77], and AUCbaseline+physical activity 0.75 [0.72-0.78]).CONCLUSIONS: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery.CLINICAL TRIAL REGISTRATION: NCT03016936.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Anestesi och int ...

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Av lärosätet: Umeå universitet; Karolinska Institutet

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Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity : international prospective cohort study

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