Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians
Abstract
:1. Introduction
1.1. Revised Cardiac Risk Index (RCRI)
1.2. National Surgical Quality Improvement Project (NSQIP)
- A surgical procedure is the treatment for the patient’s metastatic cancer.
- The patient has elected to not receive treatment for the metastatic disease.
- The patient’s metastatic cancer has been deemed untreatable.
- The patient has disseminated cancer: acute lymphocytic leukemia, acute myelogenous leukemia, or stage IV lymphoma.”
2. Discussion
3. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
References
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Risk Factor | Values |
---|---|
Elevated-risk surgery | Intraperitoneal, intrathoracic, or suprainguinal vascular = 1, all others = 0 |
History of ischemic heart disease | History of myocardial infarction; history of positive exercise test; current chest pain due to myocardial ischemia; use of nitrate therapy or electrocardiogram with pathological Q waves = 1 |
History of congestive heart failure | Pulmonary edema, bilateral rales or S3 gallop; paroxysmal nocturnal dyspnea; chest X-ray showing pulmonary vascular redistribution = 1 |
History of cerebrovascular disease | Prior transient ischemic attack or stroke = 1 |
Preoperative treatment with insulin | 1 |
Preoperative serum creatinine >2 mg/dL | 1 |
Variable | Categories |
---|---|
Age group, years | <65, 65–74, 75–84, ≥85 |
Sex | Male, female |
Functional status | Independent, partially dependent, totally dependent |
Emergency case | Yes, no |
American Society of Anesthesiologists Class | Healthy patient, mild systemic disease, severe systemic disease, severe systemic disease/constant threat to life, moribund/not expected to survive surgery |
Steroid use for chronic condition | Yes, no |
Ascites within 30 days preoperatively | Yes, no |
System sepsis within 48 h preoperatively | None, SIRS, sepsis, septic shock |
Ventilator dependence | Yes, no |
Disseminated cancer | Yes, no |
Diabetes | No, oral, insulin |
Hypertension requiring medication | Yes, no |
Previous cardiac event | Yes, no |
Congestive heart failure in 30 days preoperatively | Yes, no |
Dyspnea | No, with moderate exercise, at rest |
Current smoker within 1 year | Yes, no |
History of chronic obstructive pulmonary disease | Yes, no |
Dialysis | Yes, no |
Acute renal failure | Yes, no |
Body Mass Index Class | Underweight, normal, overweight, obese 1, obese 2, obese 3 |
Current procedural terminology-specific linear risk | 2805 values |
ACS NSQIP Surgical Risk Calculator for Primary Resection | ||||||
---|---|---|---|---|---|---|
Category | Author | Surgery | Number of Patients | Outcomes | Recommendations | |
Gastrointestinal | Alzahrai et al, 2020 [16] | Laparoscopic Gastrectomy | 207 | Brier score | Low predictability for postoperative adverse events. Suggest addition of disease or operative specific variables | |
Pneumonia | 0.009 | |||||
Any Complication | 0.154 | |||||
C-Statistic | ||||||
Pneumonia | 0.65 | |||||
Any Complication | 0.57 | |||||
Vos et al, 2020 [17] | Total Gastrectomy | 452 | Higher complication rate than predicted ACSRC (45% vs. 29%) | Predictive for cardiac complication, renal failure, death, and discharge to nursing or rehabilitation facility | ||
Brier score | ||||||
Cardiac Complication | 0.019 | |||||
Death | 0.017 | |||||
C-Statistic | ||||||
Cardiac Complications | 0.83 | |||||
Head and Neck | Vosler et al, 2018 [18] | Total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy | 107 | Underpredict Any Complication (30%) and Cardiac Complications (100%) | Potential utility for head and neck oncology. Specialty-specific calculator would adjust for specifics | |
Brier Score | ||||||
Cardiac Complications | 0.028 | |||||
Thoracic | Chudgar et al, 2020 [19] | Pulmonary Resection | 2514 | C-Statistic | Comparable risk assessment between ACSRC and SURPAS. Continued need for calibration with thoracic surgery | |
Any complication | 0.728 | |||||
Cardiac Complications | 0.821 | |||||
Death | 0.753 | |||||
Gynecologic | Rivard et al, 2016 [20] | Gynecologic Laparotomy | 1094 | Brier Score | ACSRC accurately predicts which patients might benefit from NAT in lieu of surgery due to cardiac complications or death. It does not accurately predict other complications including SSI, UTI and pneumonia | |
Cardiac Complications | 0.011 | |||||
Death | 0.008 | |||||
C-Statistic | ||||||
Cardiac Complications | 0.708 | A tailored prediction model may be needed for gynecologic oncology | ||||
Death | 0.851 | |||||
Szender et al, 2015 [21] | Gynecologic Surgery | 628 | Brier Score | Cardiac complications cannot be verified by the ACSRC and risks should be interpreted with reservation | ||
Any complication | 0.023 | |||||
Death | 0.004 | |||||
Venous Thromboembolic Event | 0.003 | |||||
Musculoskeletal | Labott et al, 2021 [22] | Proximal Femur Replacement | 103 | Overall postoperative complication rate (52%) was more than doubled for all CPT codes | ACSRC does not adequately predict complication incidence and should not be used in preoperative decision making | |
C-Statistic | ||||||
Any Complication for all CPT Codes | <0.576 |
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Johnson, E.P.; Monsour, R.; Hafez, O.; Kotha, R.; Ackerman, R.S. Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians. Clin. Pract. 2024, 14, 906-914. https://doi.org/10.3390/clinpract14030071
Johnson EP, Monsour R, Hafez O, Kotha R, Ackerman RS. Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians. Clinics and Practice. 2024; 14(3):906-914. https://doi.org/10.3390/clinpract14030071
Chicago/Turabian StyleJohnson, Emily P., Robert Monsour, Osama Hafez, Rohini Kotha, and Robert S. Ackerman. 2024. "Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians" Clinics and Practice 14, no. 3: 906-914. https://doi.org/10.3390/clinpract14030071
APA StyleJohnson, E. P., Monsour, R., Hafez, O., Kotha, R., & Ackerman, R. S. (2024). Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians. Clinics and Practice, 14(3), 906-914. https://doi.org/10.3390/clinpract14030071