Vol. 44 | No. 2 | July-December 2016 Back

Open Access

30-Day Cardiovascular Outcomes of Adult Patients Undergoing Non-cardiac Surgery at the University of Santo Tomas Hospital: A Prospective Cohort Study

Clarissa M. Mendoza, Crismelita Banez, Marcellus Francis Ramirez, Nadia Muljadi, Janelle Salazar
Dec 2016 DOI 10.69944/pjc.17c2e51156

Abstract

BACKGROUND: Approximately 3,500 non-cardiac surgeries are being performed each year in the University of Santo  Tomas Hospital (Manila, Philippines). No study has yet been made to evaluate the cardiovascular  outcomes of these surgical patients. This prospective cohort study was performed to determine the  30-day cardiovascular outcomes in patients undergoing non-cardiac surgery in the private and clinical  divisions of this institution and to evaluate the utility of currently used risk scoring systems. 

METHODS: There were 159 adult patients admitted from July to September 2015 for non-cardiac surgery who  consented for inclusion. Risk stratification was done using the Revised Cardiac Risk Index (RCRI)  and the Gupta Perioperative Risk calculator. They were followed up for major adverse cardiovascular  events (MACE) until 30 days after the surgery. 

RESULTS: Out of 159 cases, nine patients (5.7%) developed MACE, eight of whom had a cardiac arrest. All  major events occurred within 16 days following surgery. The number of comorbidities, presence of  chronic kidney disease and emergency surgery significantly predicted perioperative MACE. RCRI  had a sensitivity of 88.89%, specificity of 78.37%, positive predictive value (PPV) of 20% and  negative predictive value (NPV) of 99.15% for predicting MACE. Gupta Perioperative Risk had a  sensitivity of 77.78%, specificity of 84.46%, PPV of 23.3% and NPV of 98.43%. When combined,  the two risk scoring systems showed a sensitivity of 88.89%, specificity of 77.70%, PPV of 19.5%  and NPV of 99.14%.  

CONCLUSIONS: The 5.7% incidence of perioperative cardiovascular complications for non-cardiac surgery was  similar to that seen worldwide. Physicians must be vigilant for these complications in the first  16 days following the surgery especially in patients undergoing emergency surgery and who have  comorbidities like chronic kidney disease. RCRI is more sensitive while the Gupta Perioperative  Risk is more specific and has higher positive predictive value for the occurrence of a MACE. Both  scoring indices were useful in risk-stratifying patients.

 

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