Risk factors for perioperative major adverse cardiac events in elderly patients with coronary heart disease undergoing orthopedic surgery / 中华麻醉学杂志

ABSTRACT

Objective To identify the risk factors for perioperative major adverse cardiac events (MACEs)in elderly patients with coronary heart disease (CHD) undergoing orthopedic surgery.Methods One hundred and twenty-nine patients with CHD,aged ≥65 yr,undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009,were selected.The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery.Age,sex,history of coronary reconstruction,myocardial infarction,heart failure,angina,systemic angionosis,cerebrovascular disease and diabetes,basic and preoperative blood pressure,routine blood test,serum creatinine,blood glucose,preoperative electrocardiography (ECG) and ultrasonic cardiography,ASA,intraoperative blood transfusion,operation and anesthesia time,entering ICU after surgery and postoperative volume of drainage were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs.Results Twenty-one patients developed perioperative MACEs (16.3 %).Logistic regression analysis showed that unstable angina within 6 months,preoperative haematocrit ≤ 35%,preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this population (P ＜ 0.05),and the risk indexes of the factors were 5,3,3 and 4,respectively.Conclusion Unstable angina within 6 months,preoperative haematocrit ≤ 35 %,preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.