Evaluation of Neutrophil-Lymphocyte Ratios According to Gupta Perioperative Myocardial Infarction or Cardiac Arrest (MICA) Risk Index in Elderly Patients Undergoing Hip Surgery

Year 2023, Volume: 13 Issue: 5, 776 - 781, 30.09.2023

Bilge Banu Taşdemir Mecit , Ali Kaynak , Recep Altın , Elif Doğan Bakı , Özal Özcan , Remziye Sıvacı

Abstract

Background/Aims: Perioperative cardiac events are a leading cause of mortality after surgery. Consequently, risk stratification for perioperative myocardial ischemia and cardiac arrest has gained significant importance before surgery. The Gupta perioperative myocardial infarction or cardiac arrest (MICA) risk index provides a risk estimate for perioperative myocardial infarction or cardiac arrest. This study aimed to investigate the relationship between the MICA risk index and neutrophil-lymphocyte ratios (NLR) in elderly patients undergoing hip surgery.
Methods: The medical records of patients operated on for hip fracture surgery between 01.10.2021 and 30.04.2022 were retrospectively analyzed. Demographic data, comorbidities, clinical and laboratory characteristics, Neutrophil-to-Lymphocyte Ratio (NLR), and length of hospital stay were evaluated. Subsequently, MICA scores were computed. According to the MICA cardiac risk score, patients were categorized into two groups: a high-risk group (risk greater than 1%) and a low-risk group, and the preoperative NLR of these two groups was compared.
Results: Results: The study included 83 patients aged 65 and older out of a total of 191 patients who underwent hip fracture surgery. The patients were assessed based on their MICA cardiac risk scores, and they were categorized into two groups: those with a MICA score<1 (n=30) and those with a MICA score≥1 (n=53). Gender and body mass index (BMI) showed no significant differences between the groups. However, there were statistically significant variations observed in terms of age (p<0.001), the American Society of Anaesthesiologists (ASA) classification (p<0.001), and comorbidities (p=0.042).
Patients with a MICA score≥1 exhibited significant differences when compared to those with a MICA score<1 in terms of postoperative intensive care unit admission (p=0.003), complication rate (p<0.001), mortality (p=0.004), and length of hospital stay (p=0.025).
Furthermore, there was a positive correlation between the MICA score and preoperative NLR (Neutrophil-to-Lymphocyte Ratio) (p=0.619, r=0.055), although no significant difference was found between the two groups (p=0.486). While the NLR was higher in patients with adverse outcomes (exitus) compared to those without, this difference did not reach statistical significance (p=0.165).
Conclusions: A comprehensive multidisciplinary approach is crucial for assessing preoperative risk factors and devising appropriate treatment strategies in elderly patients undergoing hip surgery. The MICA score can serve as a valuable tool for predicting perioperative risk in this patient population. Our study revealed no significant association between preoperative NLR and the MICA cardiac risk score.

Keywords

MICA score, hip fracture surgery, NLR, perioperative period, elderly patient

Kalça Operasyonu Yapılan Yaşlı Hastalarda Gupta Perioperatif Miyokard Enfarktüsü veya Kardiyak Arrest (MICA) Risk İndeksine Göre Nötrofil-Lenfosit Oranlarının Değerlendirilmesi

Abstract

Amaç: Perioperatif kardiyak olaylar, cerrahi sonrası önde gelen ölüm nedenlerindendir. Bu nedenle, perioperatif miyokart iskemisi ve kardiyak arrest için risk sınıflaması, cerrahi öncesi önemli hale gelmiştir. Gupta perioperatif miyokard enfarktüsü veya kardiyak arrest (MICA) risk indeksi, perioperatif miyokard enfarktüsü veya kalp durması için bir risk tahmini sağlar. Bu çalışmanın amacı, kalça operasyonu geçiren yaşlı hastalarda MICA risk indeksi ve nötrofil lenfosit oranları (NLR) arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Kalça kırığı nedeniyle 01.10.2021 ve 30.04.2022 tarihleri arasında opere edilen hastaların dosyaları retrospektif olarak tarandı. Hastaların demografik bulguları, komorbiditeleri, klinik ve laboratuvar özellikleri, NLR’i, hastanede kalış süreleri değerlendirildi. MICA skorları hesaplandı. MICA kardiyak risk skoruna göre yüksek riskli grup (%1 ‘in üzeri yüksek risk) ve düşük riskli grup olarak 2 gruba ayrıldı ve bu iki grup hastaların preoperatif NLR’i karşılaştırıldı.
Bulgular: Kalça kırığı nedeniyle opere edilen 191 hastadan 65 yaş ve üzeri 83 hasta çalışmaya dahil edildi. Hastaların MICA kardiyak risk skorları hesaplanarak, MICA skoru<1 olanlar (n=30) ve MICA skoru≥1 olanlar (n=53) olarak 2’ye ayrıldı. Gruplar arasında hastaların cinsiyetleri, vücut kitle indeksleri (VKİ) açısından farklılık gözlenmezken, yaşları (p<0.001), Amerikan Anestezistler Derneği (ASA) sınıflamaları (p<0.001) ve ek hastalık açısından anlamlı farklılık mevcuttu (p=0.042). MICA skoru≥1 olan hastaların MICA skoru<1 olan hastalara göre postoperatif yoğun bakıma çıkış (p=0.003), komplikasyon görülme oranı (p<0.001), mortalite (p=0.004)ve hastane kalış süresi (p=0.025) açısından anlamlı farklılık mevcuttu. Hastaların MICA skoru ile preoperatif NLR arasında (p=0.619, r=0.055) pozitif yönlü korelasyon gözlenirken gruplar arasında anlamlı farklılık gözlenmemiştir (p=0.486). Mortalite açısından baktığımızdan exitus olanlarda NLR, olmayanlara göre daha yüksek çıksa da anlamlı farklılık gözlenmemiştir (p=0.165).
Sonuç: Kalça operasyonu olan yaşlı hastalarda preoperatif risk faktörlerinin belirlenmesi ve bu riske yönelik tedavi planlamasında multidisipliner yaklaşım önemlidir. Bu hastalarda perioperatif riski tahmin etmek için MICA skoru kullanılabilir. Çalışmamızda preoperatif NLR’nın MICA kardiyak risk skoru ile ilişkili olmadığı sonucunu bulduk.

Keywords

MICA skoru, kalça kırığı cerrahisi, NLR, perioperatif dönem, yaşlı hasta

References

• 1. Karadeniz S, Yurtbay A. Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Jt Dis Relat Surg. 2022;33(3):538-46.
• 2. Gupta PK, Gupta H, Sundaram A, et al. Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery. Circulation. 2011;124:381-7.
• 3. Peterson B, Ghahramani M, Harris S, et al. Usefulness of the Myocardial Infarction and Cardiac Arrest Calculator as a Discriminator of Adverse Cardiac Events After Elective Hip and Knee Surgery. Am J Cardiol. 2016;117(12):1992-5.
• 4. Chen YH, Chou CH, Su HH, et al. Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis. J Orthop Surg Res. 2021;16(1):681.
• 5. Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop. 2014;85(1):54-9.
• 6. Wang PW, Yao XD, Zhuang HF, Li YZ, Xu H, Lin JK, Liu WG. Mortality and Related Risk Factors of Fragile Hip Fracture. Orthop Surg. 2022;14(10):2462-2469.
• 7. Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: Is delay before surgery important? J Bone Jt Surg Am. 2005;87(3):483-9.
• 8. Forget P, Moreau N, Engel H, et al. The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF). Arch Gerontol Geriatr. 2015;60(2):366-71.
• 9. Kekeç AF, Çolak TS. Is there a predictive value of the preoperative neutrophil-lymphocyte ratio in terms of intensive care need in geriatric patients who underwent pertrochanteric fracture surgery? Ulus Travma Acil Cerrahi Derg. 2022;28(8):1164-9.
• 10. Nkanang B, Parker M, Parker E, Griffiths R. Perioperative mortality for patients with a hip fracture. Injury. 2017;48:2180-3.
• 11. Durup-Dickenson M, Nicolajsen CW, Budtz-Lilly J, Laustsen J, Eldrup N. Body Mass Index and Operating Times in Vascular Procedures. EJVES Short Rep. 2017;35:19-23.
• 12. Pereira-Macedo J, Lopes-Fernandes B, Duarte-Gamas L, et al. The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy. J Clin Med. 2022;11(21):6367.
• 13. McHugh MA, Wilson JL, Schaffer NE, et al. Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg. 2023;31(2):81-86.
• 14. Chen YH, Chou CH, Su HH, et al. Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis. J Orthop Surg Res. 2021;16(1):681.
• 15. Diniz LR, de Lima SG, de Amorim Garcia JM, de Oliveira Diniz KL. Neutrophil to Lymphocyte Ratio as a Prognostic Predictor in Older People With Acute Coronary Syndrome. Angiology. 2019;70(3):264-71.
• 16. Fisher A, Srikusalanukul W, Fisher L, Smith P. The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients. Int J Med Sci 2016;13:588-602.
• 17. Forget P, Dillien P, Engel H, Cornu O, De Kock M, Yombi JC. Use of the neutrophil-to-lymphocyte ratio as a component of a score to predict postoperative mortality after surgery for hip fracture in elderly subjects. BMC Res Notes. 2016;9:284.
• 18. Golsorkhtabaramiri M, Mckenzie J, Potter J. Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for postoperative short-term complications: a retrospective study. BMC Musculoskelet Disord. 2023;24(1):227.
• 19. Pereira-Macedo J, Lopes-Fernandes B, Duarte-Gamas L, et al. The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy. J Clin Med. 2022;11(21):6367.
• 20. Sheyn D, Mahajan S, El-Nashar S, Hijaz A, Wang XY, Mangel J. Prevalence and risk factors for cardiac arrest and myocardial infarction after pelvic reconstructive surgery: a national, multi-institutional, surgical database study. Int Urogynecol J. 2018;29(2):229-34.
• 21. Munshi AA, Yeo CJ, Lavu H, Petrou M, Komodikis G. A dynamic risk factor assessment for myocardial infarction and cardiac arrest in patients undergoing pancreatectomy. HPB (Oxford). 2022;24(5):749-58.
• 22. King S, Calisi O, Caldwell C, et al. Frequency and Predictors of Preoperative Cardiac Testing Overuse in Low-Risk Patients Before Laparoscopic Bariatric Surgery. Am J Cardiol. 2023;186:181-5.
• 23. Temiz A, Ersözlü S. Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture. Ulus Travma Acil Cerrahi Derg. 2019;25(1):71-4.