The effect of perioperative cardiac risk factors on postoperative outcomes in the elderly patients undergoing hip replacement surgery

Year 2023, Volume: 48 Issue: 3, 958 - 964, 30.09.2023

Demet Laflı Tunay , Murat Türkeün Ilgınel

https://doi.org/10.17826/cumj.1329179

Abstract

Purpose: Cardiac risk factors are among the most important determinants of postoperative outcomes in elderly surgical patients. This study aimed to determine the effect of perioperative cardiac risk factors on postoperative adverse outcomes in elderly patients undergoing total hip replacement surgery.
Materials and Methods: Patients aged 65 and older who underwent total hip replacement surgery at Cukurova University Hospital between 2014 and 2019 were analyzed retrospectively. The primary outcome measures were postoperative adverse outcomes and mortality rate.
Results: Two hundred twenty-three patients with total hip replacement surgery within five years of experience in our hospital were screened. 34.5% had postoperative cardiac, pulmonary, cerebral, and infectious morbidity and systemic inflammatory response syndrome, and the in-hospital mortality rate was 2.2%. On multivariate analysis, perioperative risk factors associated with postoperative adverse outcomes included American Society of Anesthesiologists (ASA) II physical status (aOR 5.63, 95% CI 1.75-18.11), preoperative poor functional capacity (aOR 9.50, 95% CI 3.14-28.79), traumatic fracture (aOR 2.75, 95% CI 1.22-6.24), preoperative anemia (aOR 2.15, 95% CI 1.05-4.37), and prolonged surgery (aOR 1.02, 95% CI 1.01-1.02).
Conclusion: A significant relationship was determined between preoperative poor functional capacity, pre-existing anemia, traumatic hip fracture, ASA II physical status, prolonged case duration and the risk of postoperative complications in elderly patients undergoing total hip replacement surgery.

Keywords

Cardiac risk factors, hip replacement surgery, mortality, postoperative morbidity

Kalça protezi ameliyatı yapılan yaşlı hastalarda perioperatif kardiyak risk faktörlerinin postoperatif sonuçlara etkisi

Abstract

Amaç: Kardiyak risk faktörleri, yaşlı cerrahi hastalarda postoperatif sonuçların en önemli belirleyicilerinden biridir. Bu çalışma, total kalça protezi ameliyatı geçiren yaşlı hastalarda perioperatif kardiyak risk faktörlerinin postoperatif olumsuz sonuçlara etkisini belirlemeyi amaçlamıştır.
Gereç ve Yöntem: Bu çalışmada, 2014-2019 yılları arasında Çukurova Üniversitesi Hastanesinde total kalça protezi ameliyatı geçiren 65 yaş ve üstü hastalar retrospektif olarak incelendi. Çalışmanın birincil sonuç ölçütleri postoperatif olumsuz sonuçlar ve mortalite oranıydı.
Bulgular: Hastanemizin beş yıllık tecrübesi dahilinde olan 223 total kalça protezi cerrahisi hastası tarandı. Hastaların %34,5'inde postoperatif kardiyak, pulmoner, serebral ve enfeksiyöz morbidite ile sistemik inflamatuar yanıt sendromu vardı ve hastane içi ölüm oranı %2,2 idi. Çok değişkenli analizde, postoperatif olumsuz sonuçlarla ilişkili perioperatif risk faktörleri arasında Amerikan Anestezistler Topluluğu (ASA)-II fiziksel durumu (aOR 5.63, %95 CI 1.75-18.11), preoperatif zayıf fonksiyonel kapasite (aOR 9,50, 95% GA 3,14-28,79), travmatik kırık (aOR 2,75, %95 GA 1,22-6,24), preoperatif anemi (aOR 2,15, %95 GA 1,05-4,37) ve uzamış cerrahi (aOR 1,02, %95 GA 1,01-1,02) yer almaktaydı.
Sonuç: Bu çalışmada, total kalça protezi ameliyatı geçiren yaşlı hastalarda ameliyat öncesi zayıf fonksiyonel kapasite, önceden var olan anemi, travmatik kalça kırığı, ASA II fiziksel durumu, uzamış vaka süresi ile ameliyat sonrası komplikasyon riski arasında anlamlı ilişki belirlendi.

Keywords

Kardiyak risk faktörleri, kalça protezi cerrahisi, mortalite, postoperatif morbidite

References

• Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865-77.
• Fleischmann KE, Goldman L, Young B, Lee TH. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med. 2003;115:515-20.
• Deiner S, Westlake B, Dutton RP. Patterns of surgical care and complications in elderly adults. J Am Geriatr Soc. 2014;62:829-35.
• Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med. 2014;30:175-81.
• Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373:2258-69.
• Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9.
• Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124:381-7.
• Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845-50.
• Forssten MP, Mohammad Ismail A, Sjolin G, Ahl R, Wretenberg P, Borg T et al. The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery. Eur J Trauma Emerg Surg. 2022;48:1885-92.
• Ackland GL, Harris S, Ziabari Y, Grocott M, Mythen M; SOuRCe Investigators. Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study. Br J Anaesth. 2010;105:744-52.
• Forssten MP, Mohammad Ismail A, Borg T, Ahl R, Wretenberg P, Cao Y et al. Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study. Trauma Surg Acute Care Open. 2021;6:e000778.
• Çiçek V, Cinar T, Hayiroglu MI, Kılıç Ş, Keser N, Uzun M et al. Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study. Postgrad Med J. 2021;97:701-5.
• Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev. 2021;12:CD013139.
• Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-6.
• Welten GM, Schouten O, van Domburg RT, Feringa HH, Hoeks SE, Dunkelgrün M et al. The influence of aging on the prognostic value of the revised cardiac risk index for postoperative cardiac complications in vascular surgery patients. Eur J Vasc Endovasc Surg. 2007;34:632-8.
• Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215-45.
• Marsman M, van Waes JAR, Grobben RB, Weersink CSA, van Klei WA. Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury. Eur J Prev Cardiol. 2021;28:262-9.
• Struthers R, Erasmus P, Holmes K, Warman P, Collingwood A, Sneyd JR. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. Br J Anaesth. 2008;101:774-80.
• Wijeysundera DN, Pearse RM, Shulman MA, Abbott TEF, Torres E, Ambosta A et al. METS study investigators. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018;391:2631-40.
• Berstock JR, Beswick AD, Lenguerrand E, Whitehouse MR, Blom AW. Mortality after total hip replacement surgery: A systematic review. Bone Joint Res. 2014;3:175-82.
• Gabriel RA, Sztain JF, A'Court AM, Hylton DJ, Waterman RS, Schmidt U. Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population. J Anesth. 2018;32:112-9.
• Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ et al; National Joint Registry for England, Wales and Northern Ireland. 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet. 2013;382:1097-104.
• Mamidanna R, Stonell C, Faiz O. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia. 2011;66:132-3.
• Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004;86:1983-8.
• Blanco JF, da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enríquez JM, Díaz-Álvarez A. 30-day mortality after hip fracture surgery: Influence of postoperative factors. PLoS One. 2021;16:e0246963.
• Grosso MJ, Boddapati V, Cooper HJ, Geller JA, Shah RP, Neuwirth AL. The effect of preoperative anemia on complications after total hip arthroplasty. J Arthroplasty. 2020;35:S214-8.
• Kunutsor SK, Hamal PB, Tomassini S, Yeung J, Whitehouse MR, Matharu GS. Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient-and public-informed outcomes: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2022;129:788-800.
• Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review. World J Orthop. 2014;5:336-43.
• Guay J. The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis. J Clin Anesth. 2006;18:124-8.
• Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134-44