Clinical Decisionmaking

Patients with cardiac complications following noncardiac surgery are more likely to have other complications as well

Patients undergoing noncardiac surgery who experience a cardiac complication are more likely than other patients to develop another type of complication and to have a prolonged hospital stay, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS06573). The study was led by Lee Goldman, M.D., M.P.H., of the University of California, San Francisco.

The researchers collected data on 3,970 patients aged 50 years or older who were undergoing major noncardiac procedures at one hospital. They performed serial electrocardiograms and cardiac enzyme measurements during each patient's hospital stay and recorded cardiac and noncardiac complications and their effects on length of hospital stay.

Cardiac complications occurred in 2 percent of patients, and noncardiac complications developed in 13 percent. One percent of patients suffered from both types of complications. The most common cardiac complications were pulmonary edema (42 patients) and heart attack (41 patients). The most common noncardiac complications were wound infection, confusion, respiratory failure requiring intubation, deep venous thrombosis, and bacterial pneumonia.

Patients with cardiac complications were more than six times as likely as those without complications to suffer a noncardiac complication, even after adjustment for preoperative clinical factors. Compared with patients who suffered no complications, those who had cardiac or noncardiac complications stayed in the hospital a mean of 11 days longer, and those who had both types of complications stayed a mean of 15 days longer, even after adjustment for procedure type and clinical factors.

See "Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: Outcomes and effects of length of stay," by Kirsten E. Fleischmann, M.D., M.P.H., Dr. Goldman, Belinda Young, M.S., and Thomas H. Lee, M.D., S.M., in the November 2003 American Journal of Medicine 115, pp. 515-520.

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