Postoperative troponin surveillance to detect myocardial infarction: an observational cohort modelling study.

Background: Clinical presentation of postoperative myocardial infarction (POMI) is often silent. Several international guidelines recommend routine troponin surveillance in patients at risk. We compared how these different guidelines select patients for surveillance after noncardiac surgery with our established risk stratification model.

Postoperative myocardial injury phenotypes and self-reported disability in patients undergoing noncardiac surgery: a multicentre observational study.

Background: Postoperative myocardial injury (PMI) comprises a spectrum of mechanisms resulting in troponin release. The impact of different PMI phenotypes on postoperative disability remains unknown.

Methods: This was a multicentre prospective cohort study including patients aged ≥50 yr undergoing elective major noncardiac surgery.

[Dutch guideline to prevent perioperative pulmonal complications: how is the adherence?].

Introduction: Patients with a history of chronic obstructive pulmonary disease (COPD) or asthma undergoing surgery are at risk for developing postoperative pulmonary complications, associated with morbidity and mortality. A national guideline was composed on preventive strategies in non-thoracic surgery, in which perioperative administration of corticosteroids are a cornerstone. We investigated the implementation in our hospital.

Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study.

Background: Studies of intraoperative hypotension typically specify a blood pressure threshold associated with adverse outcomes. Such thresholds are likely to be study-biased, investigator-biased, or both. We hypothesised that a newly developed modelling method without a threshold, which is biologically more plausible than a threshold-based approach, would reveal a continuous association between exposure to intraoperative hypotension and adverse outcomes.

Patient Selection for Routine Troponin Monitoring After Noncardiac Surgery.

Background Myocardial infarction is an important complication after noncardiac surgery. Therefore, perioperative troponin surveillance is recommended for patients at risk. The aim of this study was to identify patients at high risk of perioperative myocardial infarction (POMI), in order to aid appropriate selection and to omit redundant laboratory measurements in patients at low risk.

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury.

Background: Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality.

Effects of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomised crossover trial.

Background: Patients undergoing cerebral bypass surgery are prone to cerebral hypoperfusion. Currently, arterial blood pressure is often increased with vasopressors to prevent cerebral ischaemia. However, this might cause vasoconstriction of the graft and cerebral vasculature and decrease perfusion.

Reticulated Platelets as Predictor of Myocardial Injury and 30 Day Mortality After Non-cardiac Surgery.

Objective: A pre-operative marker for identification of patients at risk of peri-operative adverse events and 30 day mortality might be the percentage of young, reticulated platelets (pRP). This study aimed to determine the predictive value of pre-operative pRP on post-operative myocardial injury (PMI) and 30 day mortality, in patients aged ≥ 60 years undergoing moderate to high risk non-cardiac surgery.

Methods: The incidence of PMI (troponin I > 0.

An observational study of end-tidal carbon dioxide trends in general anesthesia.

Purpose: Despite growing evidence supporting the potential benefits of higher end-tidal carbon dioxide (ETCO) levels in surgical patients, there is still insufficient data to formulate guidelines for ideal intraoperative ETCO targets. As it is unclear which intraoperative ETCO levels are currently used and whether these levels have changed over time, we investigated the practice pattern using the Multicenter Perioperative Outcomes Group database.

Methods: This retrospective, observational, multicentre study included 317,445 adult patients who received general anesthesia for non-cardiothoracic procedures between January 2008 and September 2016.

Unexpected Cardiac Computed Tomography Findings in Patients With Postoperative Myocardial Injury.

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).

Relationship Between Preoperative Evaluation Blood Pressure and Preinduction Blood Pressure: A Cohort Study in Patients Undergoing General Anesthesia.

Background: For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room.

Methods: Cohort study including 4408 patients aged 60 years or older undergoing noncardiac surgery.

Kinetics of troponin I in patients with myocardial injury after noncardiac surgery.

Background: Myocardial injury after noncardiac surgery, as measured by troponin elevation, is strongly associated with mortality. However, it is unknown in which patients prognosis can be improved. The presence of kinetic changes of troponin may be associated with a worse prognosis and warrant more aggressive management.

One-Year Mortality, Causes of Death, and Cardiac Interventions in Patients with Postoperative Myocardial Injury.

Background: To evaluate the role of routine troponin surveillance in patients undergoing major noncardiac surgery, unblinded screening with cardiac consultation per protocol was implemented at a tertiary care center. In this study, we evaluated 1-year mortality, causes of death, and consequences of cardiac consultation of this protocol.

Methods: This observational cohort included 3224 patients ≥60 years old undergoing major noncardiac surgery.

Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery.

Background: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial injury.

[Asymptomatic myocardial infarction after non-cardiac surgery; importance of routine testing of troponin concentration].

Perioperative myocardial infarction (PMI) is associated with a high mortality rate. Detection of PMI, however, is difficult due to a lack of typical anginal symptoms associated with the use of strong analgesics. Also, characteristic changes on the electrocardiogram may be minimal and/or transient.

Myocardial injury after noncardiac surgery and its association with short-term mortality.

Background: To identify patients at risk for postoperative myocardial injury and death, measuring cardiac troponin routinely after noncardiac surgery has been suggested. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as measured by troponin elevation, on 30-day mortality after noncardiac surgery.

Artifacts in research data obtained from an anesthesia information and management system.

Purpose: Artifacts in anesthesia information management system (AIMS) databases may influence research results. Filtering during data capturing can prevent artifacts from being stored. In this prospective study, we assessed the reliability of AIMS data by determining the incidence of artifactual values stored in the AIMS.