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Global Journal of Surgery. Volume 1, Issue 1 (2010) pp. 73-84
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Research Article
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Risk Stratification in Coronary Patients Undergoing Abdominal Nonvascular Operations
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Vesna M. Karapandžića*, Milan Ž. Petrovićb ,
Zoran V. Krivokapićc and Snežana N. Protićd
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a Department of Digestive Surgery, The First Surgical Clinic, University Clinical Center of Serbia , Koste Todorovica 6, 11000 Belgrade , Serbia
b University of Belgrade and Department of Echocardiography, Clinic for Cardiovascular Diseases, University Clinical Center of Serbia , Visegradska 26, 11000 Belgrade , Serbia
c University of Belgrade and Department of Digestive Surgery, The First Surgical Clinic, University Clinical Center of Serbia , Koste Todorovica 6, 11000 Belgrade , Serbia
d Department of Anaesthesia, The First Surgical Clinic, University Clinical Center of Serbia , Koste Todorovica 6, 11000 Belgrade , Serbia
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Abstract |
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Introduction: Coronary patients undergoing open abdominal nonvascular operations under general anesthesia are at increased risk of perioperative morbidity and mortality. The objective of our study was to establish that the incidence of all types of perioperative cardiac complications significantly increased with operative risk assessed by the “American Society of Anesthesiologists Physical Status” classification system (ASA-PS). Experimental: Our prospective observational clinical study included 111 consecutive patients with angiographically verified coronary artery disease, having undergone open abdominal nonvascular operations under general anesthesia at a University hospital. The patients were divided into stratification subgroups according to ASA-PS and were compared in relation to frequency of perioperative cardiac complications. During the surgery as well as in the immediate post-operative 72 hours, the patients were monitored by continuous ST-T segment monitoring. 12-lead electrocardiography was performed immediately after surgery, on postoperative days 1, 2, 7 and one day before discharge from hospital. Cardiac biomarkers were evaluated at 6 h, 24 h and 96 hours following the operation. The patients were followed on daily basis till 30th postoperative day. Statistical design was presented by Pearson's χ2 test and binomial logistic regression. Results: The main result of our study was a significant difference in mortality to postoperative day 30 between three subgroups - ASA II 0/28(0.0%) vs ASA III 1/53(1.8%) vs ASA IV 4/30(13.3%) p<0.05. Conclusions: Significant difference in incidence of perioperative minor, major, and fatal cardiac complications between all three ASA-PS grading subgroups; that the incidence of minor, major, and fatal perioperative cardiac complications significantly increased with the ASA-PS grading; that the ASA-PS grading was adequate for risk assessment in coronary patients undergoing open abdominal nonvascular operations during general anesthesia.
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Keywords |
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Risk assessment; Coronary artery disease; Surgery; Risk factors; Complications
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