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Original Investigation
February 2017

Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, New York University School of Medicine, New York
  • 2Department of Medicine, Medical College of Wisconsin, Milwaukee
  • 3Department of Anesthesiology, Mayo Clinic Arizona, Phoenix
JAMA Cardiol. 2017;2(2):181-187. doi:10.1001/jamacardio.2016.4792
Key Points

Question  What are the trends in perioperative major adverse cardiovascular events (MACCE) after noncardiac surgery in the United States?

Finding  In this analysis of patients undergoing in-hospital major noncardiac surgery from 2004 to 2013, the frequency of MACCE declined from 3.1% to 2.6% driven by a decline in frequency of perioperative death and acute myocardial infarction but an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013.

Meaning  Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery; despite reductions in the rate of death and acute myocardial infarction among patients undergoing major noncardiac surgery in the United States, perioperative ischemic stroke increased over time.

Abstract

Importance  Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery.

Objective  To evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions.

Design, Setting, Participants  Patients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample.

Main Outcomes and Measures  Perioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time.

Results  Among 10 581 621 hospitalizations (mean [SD] patient age, 65.74 [12.32] years; 5 975 798 female patients 56.60%]) for major noncardiac surgery, perioperative MACCE occurred in 317 479 hospitalizations (3.0%), corresponding to an annual incidence of approximately 150 000 events after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (P for trend <.001; adjusted odds ratio [aOR], 0.95; 95% CI, 0.94-0.97) driven by a decline in frequency of perioperative death (aOR, 0.79; 95% CI, 0.77-0.81) and AMI (aOR, 0.87; 95% CI, 0.84-0.89) but an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (P for trend <.001; aOR 1.79; CI 1.73-1.86).

Conclusions and Relevance  Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major noncardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing noncardiac surgery.

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