Articles  |   September 2018
SEE Question
Article Information
Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Education / CPD / Articles
Articles   |   September 2018
SEE Question
ASA Monitor 9 2018, Vol.82, 50.
ASA Monitor 9 2018, Vol.82, 50.
According to a recent prospective cohort study, which of the following risk factors is most predictive of 30-day mortality in patients undergoing inpatient noncardiac surgery?
The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study was a multinational prospective study of more than 21,000 patients designed to identify diagnostic criteria for myocardial injury after noncardiac surgery based on the peak postoperative hsTnT value. The investigators sought to determine the hsTnT threshold that would predict a three-fold increase in the risk for all-cause 30-day mortality.
Patients underwent major noncardiac surgery, defined by the need for inpatient admission. In descending order of frequency, procedures included general surgery, orthopedics, urologic or gynecologic, and vascular or neurosurgical. All patients were older than 45 years. Fifty-three percent of patients had general anesthesia alone, 23 percent had neuraxial anesthesia alone, and 17 percent received a combination of general and regional anesthesia. The investigators used a prespecified, complex statistical methodology to identify the association between peak postoperative hsTnT and 30-day mortality. Any hsTnT value greater than 20 ng/L was associated with 30-day mortality; hsTnT greater than 1,000 ng/L predicted a risk of mortality greater than 200 times the baseline risk of a patient with no postoperative troponin elevation.
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