Scopus
🔓 Açık Erişim YÖKSİS Eşleşti
Association between postoperative haemoglobin and myocardial injury after noncardiac surgery: a retrospective cohort analysis
British Journal of Anaesthesia · Ocak 2021
YÖKSİS Kayıtları
Association between postoperative haemoglobin and myocardial injury after noncardiac surgery: a retrospective cohort analysis
British Journal of Anaesthesia · 2021 SCI-Expanded
PROFESÖR İBRAHİM ÖZKAN ÖNAL →
Makale Bilgileri
DergiBritish Journal of Anaesthesia
Yayın TarihiOcak 2021
Cilt / Sayfa126 · 94-101
Scopus ID2-s2.0-85091603663
Erişim🔓 Açık Erişim
Özet
Background: Myocardial injury after noncardiac surgery (MINS) is common, mostly silent, and a strong predictor of postoperative mortality. MINS appears to result from myocardial supply–demand mismatch. Recent data support restrictive perioperative transfusion strategies that can result in low postoperative haemoglobin concentrations. Whether low postoperative haemoglobin is associated with myocardial injury remains unknown. We therefore tested the hypothesis that anaemia is associated with an increased risk of myocardial injury in adults having noncardiac surgery. Methods: We conducted a retrospective analysis of adults ≥45 yr old who had routine postoperative troponin T (TnT) monitoring after noncardiac surgery at the Cleverland Clinic (including those enrolled in the PeriOperative ISchemic Evaluation-2 Trial [POISE-2], the Safety of Addition of Nitrous Oxide to General Anaesthesia in At-risk Patients Having Major Non-cardiac Surgery [ENIGMA-II], Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study [VISION], and Anaesthetic Depth and Complications After Major Surgery [BALANCED] trial). Patients with baseline increase in TnT and non-ischaemic aetiologies for TnT increase were excluded. The association between postoperative haemoglobin concentration during the 3 initial postoperative days and the incidence of MINS (fourth-generation TnT ≥0.03 ng ml−1 judged as attributable to ischaemia) was assessed using a time-varying covariate Cox proportional hazards survival analysis. Results: Among 6141 patients, 4480 were analysed. The incidence of MINS was 155/4480 (3.5%), ranging from 0/345 (0%) among patients whose lowest postoperative haemoglobin exceeded 13 g dl−1 to 52/611 (8.5%) in patients whose minimum postoperative haemoglobin was <8 g dl−1. The confounder-adjusted hazard ratio [95% confidence interval] for having MINS was 1.29 [1.16–1.42] for every 1 g dl−1 decrease in postoperative haemoglobin in a time-varying covariate analysis. Similar associations were identified in sensitivity analyses. Conclusion: Lower postoperative haemoglobin values are associated with MINS. Whether this association is modifiable by prevention or treatment of anaemia remains to be determined.
Yazarlar (12)
1
Alparslan Turan
2
Barak Cohen
3
Eva Rivas
4
Liu Liu
5
Xuan Pu
6
Kamal Maheshwari
7
Ehab Farag
8
Ozkan Onal
ORCID: 0000-0002-5574-1901
9
Jiayi Wang
10
Kurt Ruetzler
11
Philip J. Devereaux
12
Daniel I. Sessler
Anahtar Kelimeler
anaesthesia
cardiovascular risk
noncardiac surgery
perioperative anaemia
postoperative outcomes
Kurumlar
Cleveland Clinic Foundation
Cleveland United States
Hamilton Health Sciences
Hamilton Canada
McMaster University
Hamilton Canada
Tel Aviv University
Tel Aviv-Yafo Israel
Universitat de Barcelona
Barcelona Spain
Metrikler
39
Atıf
12
Yazar
5
Anahtar Kelime