Vascular Events Main Contributors in Non-Cardiac Surgical Deaths

Three-quarters of all deaths following non-cardiac surgery are due to myocardial injury, major bleeding, and sepsis, according to a new study.

Researchers at McMaster University (Hamilton, ON, Canada), the University of Kwazulu-Natal (Durban, South Africa), and other institutions conducted a study involving 40,004 patients (45 years or older) who underwent non-cardiac surgery, remaining in hospital for at least one night. The patients were recruited from 27 medical centers in 14 countries in North and South America, Asia, Europe, Africa, and Australia, and monitored for complications until 30 days after their surgery.

The results showed that 715 (1.8%) of the patients died within 30 days of surgery. Of those, 71% died in hospital, and 29% died following discharge. Eight perioperative complications were associated with post-operative death within 30 days of surgery, with the top three complications, contributing to nearly three-quarters of all deaths, being myocardial injury after noncardiac surgery (MINS; 29%), major bleeding (25%), and sepsis (20%). Other complications included congestive heart failure (CHF), deep venous thrombosis (DVT), stroke, infections, and acute kidney injury (AKI). The study was presented at the European Society of Cardiology (ESC) annual congress, held during August 2018 in Munich (Germany).

“There’s a false assumption among patients that once you’ve undergone surgery, you’ve ‘made it’. Unfortunately, that’s not always the case, and now we have a much better sense of when and why people die after non-cardiac surgery,” said study author anaesthesiologist Jessica Spence, MD, of McMaster University. “These discoveries tell us that we need to become more involved in care and monitoring after surgery to ensure that patients at risk have the best chance for a good recovery.”

“We’re letting patients down in postoperative management. Most deaths after non-cardiac surgery are due to cardiovascular causes, so cardiologists have a major role to play to improve patient safety,” said senior author Professor Philip Devereaux, MD, director of cardiology at McMaster University. “This includes conducting blood and imaging tests to identify patients at risk, and then giving preventive treatment, including medications that prevent abnormal heart rhythms, lower blood pressure, and cholesterol, and prevent blood clots.”

A simple blood test for high-sensitivity cardiac troponin I (cTnI) can speedily detect MINS at an early stage, and is superior in terms of sensitivity and specificity to cardiac muscle enzyme measurements for the identification of cardiac muscle damage.

Related Links:
McMaster University
University of Kwazulu-Natal