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https://www.readbyqxmd.com/read/29146612/derivation-and-validation-of-a-geriatric-sensitive-perioperative-cardiac-risk-index
#1
Rami Alrezk, Nicholas Jackson, Mohanad Al Rezk, Robert Elashoff, Nancy Weintraub, David Elashoff, Gregg C Fonarow
BACKGROUND: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors...
November 16, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29132159/aspirin-in-patients-with-previous-percutaneous-coronary-intervention-undergoing-noncardiac-surgery
#2
Michelle M Graham, Daniel I Sessler, Joel L Parlow, Bruce M Biccard, Gordon Guyatt, Kate Leslie, Matthew T V Chan, Christian S Meyhoff, Denis Xavier, Alben Sigamani, Priya A Kumar, Marko Mrkobrada, Deborah J Cook, Vikas Tandon, Jesus Alvarez-Garcia, Juan Carlos Villar, Thomas W Painter, Giovanni Landoni, Edith Fleischmann, Andre Lamy, Richard Whitlock, Yannick Le Manach, Meylin Aphang-Lam, Juan P Cata, Peggy Gao, Nicolaas C S Terblanche, Pamidimukkala V Ramana, Kim A Jamieson, Amal Bessissow, Gabriela R Mendoza, Silvia Ramirez, Pierre A Diemunsch, Salim Yusuf, P J Devereaux
Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment...
November 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29132156/low-dose-aspirin-to-reduce-the-risk-for-myocardial-infarction-among-patients-with-coronary-stents-undergoing-noncardiac-surgery
#3
Raffaele Piccolo, Stephan Windecker
No abstract text is available yet for this article.
November 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29119935/perioperative-management-of-hyperlipidemia-medications
#4
J Ross Renew
BACKGROUND: Coronary artery disease is a common comorbidity encountered during the perioperative period. Whether patients are scheduled for cardiac or noncardiac surgery, this cardiovascular disease must be addressed in the preoperative period to decrease the accompanying risks and potential postoperative problems. Lipid-lowering medications are often used to treat hyperlipidemia, a risk factor for the development of atherosclerosis and coronary artery disease. OBJECTIVE: To discuss the medications most commonly used to treat hyperlipidemia and to describe strategies for handling these treatment regimens in the perioperative period...
November 7, 2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29099425/unexpected-cardiac-computed-tomography-findings-in-patients-with-postoperative-myocardial-injury
#5
Remco B Grobben, Judith A R van Waes, Tim Leiner, Linda M Peelen, Gert Jan de Borst, Henri C Vogely, Diederick E Grobbee, Pieter A Doevendans, Wilton A van Klei, Hendrik M Nathoe
BACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA). METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery...
November 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29055835/preoperative-severe-hypoalbuminemia-is-associated-with-an-increased-risk-of-postoperative-delirium-in-elderly-patients-results-of-a-secondary-analysis
#6
Dan-Feng Zhang, Xian Su, Zhao-Ting Meng, Fan Cui, Hong-Liang Li, Dong-Xin Wang, Xue-Ying Li
PURPOSE: To explore the association between the severity of preoperative hypoalbuminemia and the occurrence of postoperative delirium. MATERIALS AND METHODS: This was a secondary analysis of the database from a previously conducted clinical trial. 700 elderly patients (age ≥65years) who were admitted to intensive care unit (ICU) after noncardiac surgery were included. Delirium was assessed with the Confusion Assessment Method for the ICU twice daily during the first 7days postoperatively...
September 29, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29026353/association-of-body-mass-index-and-postoperative-acute-kidney-injury-in-patients-undergoing-laparoscopic-surgery
#7
Maged Y Argalious, Natalya Makarova, Alexander Leone, Jacek Cywinski, Ehab Farag
BACKGROUND: Whether the deleterious effects of carbon dioxide pneumoperitoneum on the kidneys are exacerbated in the obese population remains unknown. We hypothesized that increased body mass index (BMI) is associated with an increased incidence of postoperative acute kidney injury (AKI) in patients undergoing noncardiac laparoscopic surgery. METHODS: Following institutional review board approval, we analyzed data on 8,543 adult patients with American Society of Anesthesiologists physical status scores of I-IV who had inpatient noncardiac laparoscopic surgery from 2005-2014...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/29026330/parecoxib-relieves-pain-and-has-an-opioid-sparing-effect-following-major-gastrointestinal-surgery
#8
Margaret Noyes Essex, Hao Xu, Bruce Parsons, Li Xie, Chunming Li
PURPOSE: Parecoxib provides analgesia following a variety of surgeries, including minor gastrointestinal procedures. To our knowledge, there is no data on parecoxib following major gastrointestinal surgery. This study assessed the efficacy and opioid-sparing effects of parecoxib following major gastrointestinal surgeries. PATIENTS AND METHODS: Patients in this analysis were a subset from a large, randomized, double-blind, placebo-controlled trial of parecoxib following noncardiac surgeries and consisted of those undergoing a variety of major gastrointestinal surgeries via laparotomy...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28967730/goals-of-surgery-and-assessment-tools-for-elderly-patients-referred-for-cardiac-and-noncardiac-surgery
#9
Flaminia Coccia, Renzo Rozzini
Surgery in elderly patients is associated with the risk of death, complications, functional decline and disability. Prior to surgery, therefore, an assessment of the health-related priorities, a realistic evaluation of the surgical risks, and individualized optimization of the procedural pathway to follow are mandatory.
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967723/preoperative-cardiac-risks-in-noncardiac-surgery-the-role-of-coronary-angiography
#10
Carlo Lombardi, Marco Sbolli, Dario Cani, Garbriele Masini, Marco Metra, Pompilio Faggiano
The preoperative  evaluation of  patients candidates  to noncardiac  surgery requires a knowledge  of  factors  related  both to  type of  surgery and  to  features of the  single patient, potentially  responsible  for  perioperative  cardiovascular  complications , fatal and nonfatal. The assessment of   symptoms  and/or noninvasive  testing indicating the  presence of  coronary  artery  disease may  suggest the  need  for  medical therapy  optimization and, eventually, coronary  arteriography  before  the  scheduled timing  of noncardiac  surgery...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967720/current-multivariate-risk-scores-in-patients-undergoing-non-cardiac-surgery
#11
Gian Francesco Mureddu
Several indexes to predict perioperative cardiovascular risk have been proposed overtime. The most widely used is the Revised Cardiac Risk Index (RCRI) developed by Lee since 1999. It predicts major cardiac outcomes from five independent clinical determinants: history of ischemic heart disease, history of cardiovascular disease, heart failure, insulin-dependent diabetes mellitus, and chronic renal failure (i.e. serum creatinine >2 mg/dl). In external validation studies, the RCRI showed high negative predictive value in all groups of age, indicating that it may be used to identify people at low risk for perioperative adverse cardiovascular events in noncardiac surgery...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967164/negative-predictive-value-of-dobutamine-stress-echocardiography-for-perioperative-risk-stratification-in-patients-with-cardiac-risk-factors-and-reduced-exercise-capacity-undergoing-non-cardiac-surgery
#12
Gus Go, Kathy T Davies, Cara O'Callaghan, Wendy Senior, Karam Kostner, Narelle Fagermo, Sandhir B Prasad
BACKGROUND: Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with >1 recognised cardiac risk factors and self-reported reduced exercise capacity. We sought to determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major noncardiac surgery. METHODS: Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre was retrospectively reviewed to determine rates of Major Adverse Cardiac Events (MACE) during the index hospitalisation and 30 days post discharge...
October 2, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28943515/bleeding-impacting-mortality-after-noncardiac-surgery-a-protocol-to-establish-diagnostic-criteria-estimate-prognostic-importance-and-develop-and-validate-a-prediction-guide-in-an-international-prospective-cohort-study
#13
Pavel S Roshanov, John W Eikelboom, Mark Crowther, Vikas Tandon, Flavia K Borges, Clive Kearon, Andre Lamy, Richard Whitlock, Bruce M Biccard, Wojciech Szczeklik, Gordon H Guyatt, Mohamed Panju, Jessica Spence, Amit X Garg, Michael McGillion, Tomas VanHelder, Peter A Kavsak, Justin de Beer, Mitchell Winemaker, Daniel I Sessler, Yannick Le Manach, Tej Sheth, Jehonathan H Pinthus, Lehana Thabane, Marko R I Simunovic, Ryszard Mizera, Sebastian Ribas, P J Devereaux
INTRODUCTION: Various definitions of bleeding have been used in perioperative studies without systematic assessment of the diagnostic criteria for their independent association with outcomes important to patients. Our proposed definition of bleeding impacting mortality after noncardiac surgery (BIMS) is bleeding that is independently associated with death during or within 30 days after noncardiac surgery. We describe our analysis plan to sequentially 1) establish the diagnostic criteria for BIMS, 2) estimate the independent contribution of BIMS to 30-day mortality and 3) develop and internally validate a clinical prediction guide to estimate patient-specific risk of BIMS...
August 4, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28925651/exercise-stress-testing-indications-and-common-questions
#14
Kathryn K Garner, William Pomeroy, James J Arnold
Exercise stress testing is a validated diagnostic test for coronary artery disease in symptomatic patients, and is used in the evaluation of patients with known cardiac disease. Testing of asymptomatic patients is generally not indicated. It may be performed in select deconditioned adults before starting a vigorous exercise program, but no studies have compared outcomes from preexercise testing vs. encouraging light exercise with gradual increases in exertion. Preoperative exercise stress testing is helpful for risk stratification in patients undergoing vascular surgery or who have active cardiac symptoms before undergoing nonemergent noncardiac surgery...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28885501/outcomes-of-abdominal-surgery-in-patients-with-mechanical-ventricular-assist-devices-a-multi-institutional-study
#15
Krystle M Leung, Maria X Kiely, Ashlee Kimbrell, Ammar Asban, Rosemary Kelley, Ronald Bleday, Jennifer S Davids, Nelya Melnitchouk
OBJECTIVE: The aim of this study was to examine the outcomes of elective and emergent abdominal operations performed in end-stage heart failure patients supported with ventricular assist devices (VADs). SUMMARY OF BACKGROUND DATA: With the growing volume of end-stage heart failure patients receiving VADs, an increasing number of these patients require surgery for noncardiac pathology. There is a paucity of studies on the safety of abdominal operations in this population...
September 6, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28857811/biomarker-guided-intervention-to-prevent-acute-kidney-injury-after-major-surgery-the-prospective-randomized-bigpak-study
#16
Ivan Göcze, Dominik Jauch, Markus Götz, Pascal Kennedy, Bettina Jung, Florian Zeman, Carsten Gnewuch, Bernhard M Graf, Wolfgang Gnann, Bernhard Banas, Thomas Bein, Hans J Schlitt, Tobias Bergler
OBJECTIVE: To determine the impact of renal biomarker-guided implementation of the Kidney Disease Improving Global Outcomes (KDIGO) care bundle on the incidence of acute kidney injury (AKI) after major noncardiac surgery in a single-center unblinded randomized clinical trial. BACKGROUND: Early optimization of volume status and discontinuation of nephrotoxic medication before the occurrence of AKI may be the crucial step to reduce preventable AKI. METHODS: The urinary biomarker-triggered KDIGO care bundle (early optimization of fluid status, maintenance of perfusion pressure, discontinuation of nephrotoxic agents) was compared to standard intensive care unit (ICU) care in 121 patients with an increased AKI risk after major abdominal surgery that was determined by urinary biomarker (inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7) >0...
August 29, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28826683/perioperative-management-of-dual-antiplatelet-therapy-in-patients-with-new-generation-drug-eluting-metallic-stents-and-bioresorbable-vascular-scaffolds-undergoing-elective-noncardiac-surgery
#17
REVIEW
Michael Essandoh, Adam A Dalia, Mazen Albaghdadi, Barry George, Nicoleta Stoicea, Muhammad Shabsigh, Sunil V Rao
Dual-antiplatelet therapy (DAPT) is considered mandatory after new-generation drug-eluting coronary stent implantation to reduce ischemic complications such as stent thrombosis, but the need for DAPT makes the timing of elective surgery difficult. Interrupting DAPT places patients at risk for stent thrombosis, and surgery in the setting of DAPT may lead to bleeding. The 2016 American College of Cardiology/American Heart Association guideline recommends delaying elective noncardiac surgery for a minimum 6-month period to reduce ischemic risks after the implantation of a second-generation metallic drug-eluting stent (DES)...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28822388/outcomes-following-noncardiac-surgery-in-patients-with-ventricular-assist-devices-a-single-center-experience
#18
Shawna M Kettyle, Nikhil L Chervu, Appajosula Sarada Rao, Salaam Sadi, David Majure, Jack A Sava, Laura S Johnson
the prevalence of ventricular assist devices (VADs) is increasing as advanced cardiac therapies progress. These patients commonly require non-cardiac surgical procedures (NCS), although data are scant regarding the safety, timing, and operations that may safely be performed. We aim to describe our experience with VAD patients undergoing NCS. We retrospectively reviewed records on patients who underwent NCS after VAD implantation between 2013 and 2015 at a single Joint Commission-accredited VAD institution. Data collection included demographics, ischemic cardiomyopathy or nonischemic cardiomyopathy, operative details, and perioperative anticoagulation management and outcomes...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28820797/postoperative-renal-dysfunction-after-noncardiac-surgery
#19
Suvi T Vaara, Rinaldo Bellomo
PURPOSE OF REVIEW: The narrative review aims to discuss recent results and important knowledge gaps regarding acute kidney injury (AKI) in postoperative patients undergone major noncardiac surgery. RECENT FINDINGS: Postoperative AKI affects approximately one-fifth of patients after major surgery, but the incidence varies according to the type of surgery. Preexisting chronic kidney disease is a major risk factor for postoperative AKI. It carries a substantial risk for postoperative adverse outcomes, as well as long-term mortality and morbidity...
October 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28816783/association-of-testosterone-replacement-therapy-and-the-incidence-of-a-composite-of-postoperative-in-hospital-mortality-and-cardiovascular-events-in-men-undergoing-noncardiac-surgery
#20
Maged Y Argalious, Jing You, Guangmei Mao, Daniel Ramos, Sandeep Khanna, Kamal Maheshwari, Carlos Trombetta
BACKGROUND: Whether patients on testosterone replacement therapy undergoing noncardiac surgery have an increased risk of postoperative in-hospital mortality and cardiovascular events remains unknown. We therefore sought to identify the impact of testosterone replacement on the incidence of a composite of postoperative in-hospital mortality and cardiovascular events in men undergoing noncardiac surgery. METHODS: Data from male American Society of Anesthesiologists I through IV patients 40 yr or older who underwent noncardiac surgery between May 2005 and December 2015 at the Cleveland Clinic (Cleveland, Ohio) main campus were included...
September 2017: Anesthesiology
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