Newly Published
Perioperative Medicine  |   April 2020
Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery: A Cohort Study
Author Notes
  • From the School of Epidemiology and Public Health (S.M., D.I.M., D.A.F.), Faculty of Medicine (S.M., D.I.M., D.A.F., M.M.L.), Department of Cellular and Molecular Medicine (M.M.L.), University of Ottawa, Ottawa, Canada; the Clinical Epidemiology Program (S.M., D.I.M., D.A.F., M.M.L.), Blueprint Translational Research Group (S.M., D.A.F., M.M.L.), the Regenerative Medicine Program (M.M.L.), Ottawa Hospital Research Institute, Ottawa, Canada; and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital (D.I.M., M.M.L.), University of Ottawa, Ottawa, Canada; and the R. Fraser Elliot Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management University Health Network, Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada (W.S.B.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication January 22, 2019. Accepted for publication March 30, 2020.
    Submitted for publication January 22, 2019. Accepted for publication March 30, 2020.×
  • Correspondence: Address correspondence to Dr. Lalu: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail Stop 249 Ottawa, Ontario, Canada, K1Y 4E9. mlalu@toh.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Patient Safety / Quality Improvement
Perioperative Medicine   |   April 2020
Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery: A Cohort Study
Anesthesiology Newly Published on April 27, 2020. doi:https://doi.org/10.1097/ALN.0000000000003330
Anesthesiology Newly Published on April 27, 2020. doi:https://doi.org/10.1097/ALN.0000000000003330
Abstract

Background: Compared to other perioperative complications, failure to rescue (i.e., death after suffering a complication) is highest after perioperative myocardial infarction (a myocardial infarction that occurs intraoperatively or within 30 days after surgery). The purpose of this study was to identify patient and surgical risk factors for failure to rescue in patients who have had a perioperative myocardial infarction.

Methods: Individuals who experienced a perioperative myocardial infarction after noncardiac surgery between 2012 and 2016 were identified from the American College of Surgeons (Chicago, Illinois) National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue. Subgroup and sensitivity analyses evaluated the robustness of primary findings.

Results: The authors identified 1,307,884 individuals who had intermediate to high-risk noncardiac surgery. A total of 8,923 (0.68%) individuals had a perioperative myocardial infarction, of which 1,726 (19.3%) experienced failure to rescue. Strongest associations (adjusted odds ratio greater than 1.5) were age 85 yr or older (2.52 [95% CI, 2.05 to 3.09] vs. age younger than 65 yr), underweight body mass index (1.53 [95% CI, 1.17 to 2.01] vs. normal body mass index), American Society of Anesthesiologists class IV (1.76 [95% CI, 1.33 to 2.31] vs. class I or II) and class V (3.48 [95% CI, 2.20 to 5.48] vs. class I or II), and presence of: ascites (1.81 [95% CI, 1.15 to 2.87]), disseminated cancer (1.54 [95% CI, 1.18 to 2.00]), systemic inflammatory response syndrome (1.55 [95% CI, 1.26 to 1.90]), sepsis (1.75 [95% CI, 1.39 to 2.20]), septic shock (1.79 [95% CI, 1.34 to 2.37]), and dyspnea at rest (1.94 [95% CI, 1.32 to 2.86]). Patients who had emergency surgery, high-risk procedures, and postoperative complications were at higher risk of failure to rescue.

Conclusions: Routinely identified patient and surgical factors predict risk of failure to rescue after perioperative myocardial infarction.

Editor’s Perspective:

What We Already Know about This Topic:

  • Patients experiencing perioperative myocardial infarction are at high risk for mortality

  • Which patients are at highest risk of failure to rescue (death after a complication)

What This Article Tells Us That Is New:

  • In a multinational cohort of 8,923 patients experiencing perioperative myocardial infarction after intermediate to high-risk noncardiac surgery, one in five died within 30 days

  • Patients age 85 yr or older, and those with advanced systemic disease, underweight body mass index, ascites, disseminated cancer, sepsis, or dyspnea at rest were at highest risk