ABSTRACT
BACKGROUND: Recommendations on the diagnosis and management of myocardial injury in noncardiac surgery (MINS) show remarkable variability. Mortality reports also vary. We aimed to describe mortality and major adverse cardiovascular and cerebrovascular event (MACCE) rates in patients with silent MINS treated with postoperative aspirin-statin therapy and with cardiology follow-up. METHODS: Prospective descriptive cohort study of patients aged 45 years or older scheduled for noncardiac surgery with high risk for cardiovascular complications from May 2017 to April 2019. Aspirin-statin therapy and cardiology follow-up were prescribed for patients with silent (asymptomatic) MINS. The primary outcome was one-year mortality in patients with silent MINS, diagnosed by troponin concentration. Secondary outcomes were mortality in MINS patients with perioperative myocardial infarction (PMI) or chronic myocardial injury (CMI) and MACCE. RESULTS: We identified 766 eligible patients and enrolled 747. MINS occurred in 166 patients (22.2%); 151 (91%) had silent MINS and 15 (9%) had PMI. Thirty-one patients (4.1%) had CMI. One-year mortality was higher in patients with silent MINS (22.5%) than in patients with no MINS (7.8%) (P<0.001). One-year mortality rates in MINS patients with PMI or CMI were 27 and 19%, respectively. MACCE were more frequent in patients with silent MINS at 30 days and one year (18 and 25%) than in patients with no MINS (6 and 12%, respectively). CONCLUSIONS: Rates of mortality and MACCE in patients with silent MINS were high despite aspirin-statin therapy and cardiology follow-up. Further prospective research is needed to assess new postoperative care protocols that might effectively improve outcomes.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors , Myocardial Infarction , Humans , Aspirin/adverse effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Cohort Studies , Postoperative Complications/etiology , Incidence , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Risk FactorsABSTRACT
BACKGROUND: During the COVID-19 crisis it was necessary to generate a specific care network and reconvert operating rooms to attend emergency and high-acuity patients undergoing complex surgery. The aim of this study is to classify postoperative complications and mortality and to assess the impact that the COVID-19 pandemic may have had on the results. METHODS: this is a non-inferiority retrospective observational study. Two different groups of surgical patients were created: Pre-pandemic COVID and Pandemic COVID. Severity of illness was rated according to the Diagnosis-related Groups (DRG) score. Comparisons were made between groups and between DRG severity score-matched samples. Non-inferiority was set at up to 10 % difference for grade III to V complications according to the Clavien-Dindo classification, and up to 2 % difference in mortality. RESULTS: A total of 1649 patients in the PreCOVID group and 763 patients in the COVID group were analysed; 371 patients were matched for DRG severity score 3-4 (236 preCOVID and 135 COVID). No differences were found in relation to re-operation (22.5 % vs. 21.5 %) or late admission to critical care unit (5.1 % vs. 4.5 %). Clavien grade III to V complications occurred in 107 patients (45.3 %) in the PreCOVID group and in 56 patients (41.5 %) in the COVID group, and mortality was 12.7 % and 12.6 %, respectively. During the pandemic, 3 % of patients tested positive for Covid-19 on PCR: 12 patients undergoing elective surgery and 11 emergency surgery; there were 5 deaths, 3 of which were due to respiratory failure following Covid-19-induced pneumonia. CONCLUSIONS: Although this study has some limitations, it has shown the non-inferiority of surgical outcomes during the COVID pandemic, and indicates that resuming elective surgery is safe. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04780594 .
Subject(s)
COVID-19/epidemiology , Postoperative Complications/epidemiology , Surgical Procedures, Operative , Aged , COVID-19/mortality , Causality , Female , Humans , Male , Middle Aged , Pandemics , Patient Acuity , Postoperative Complications/mortality , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Durante el año 1990 se realizaron medidas de 17 parámetros fisicoquímicos, con el objetivo fundamental de obtener información sobre el estado actual del río Grande y Castro (provincia de La Coruña, N.O. de España), en lo que respecta a la calidad de sus aguas, puesto que va a permitir controlar aquellos puntos que presentan elevadas cotas de contaminación y que constituyen un evidente peligro para el medio ambiente y que va a afectar a la colectividad humana. El estudio realizado permite deducir el buen estado general de las aguas
Subject(s)
Fresh Water/analysis , Surface Waters , Water Quality Criteria , Water Pollution/analysis , Fresh Water/chemistry , Water Quality , Water Pollution/prevention & control , SpainABSTRACT
Se ha realizado un estudio sobre el contenido de metales en aguas del río Grande y Castro, situados en la privincia de La Coruña (N.O. de España), durante 1990, determinándose la concentración de los siguientes metales: Na, K, Ca, Mg, Fe, Co, Ni, Mn, Pb, Zn, Cd y Cu, lo cual es importante por la relación entre ciertos tipos de cánceres y lesiones cardiovasculares con altos contenidos de metales. Los resultados obtenidos permiten deducir el buen estado global de las aguas
Subject(s)
Fresh Water/analysis , Water Quality Criteria , Water Quality , Cations/analysis , Fresh Water/chemistry , Specimen Handling/standards , SpainABSTRACT
Durante el año 1990 se realizaron medidas de 17 parámetros fisicoquímicos, con el objetivo fundamental de obtener información sobre el estado actual del río Grande y Castro (provincia de La Coruña, N.O. de España), en lo que respecta a la calidad de sus aguas, puesto que va a permitir controlar aquellos puntos que presentan elevadas cotas de contaminación y que constituyen un evidente peligro para el medio ambiente y que va a afectar a la colectividad humana. El estudio realizado permite deducir el buen estado general de las aguas
Subject(s)
Water Pollution/analysis , Fresh Water/analysis , Surface Waters , Water Quality Criteria , Water Pollution/prevention & control , Fresh Water/chemistry , Spain , Water QualityABSTRACT
Se ha realizado un estudio sobre el contenido de metales en aguas del río Grande y Castro, situados en la privincia de La Coruña (N.O. de España), durante 1990, determinándose la concentración de los siguientes metales: Na, K, Ca, Mg, Fe, Co, Ni, Mn, Pb, Zn, Cd y Cu, lo cual es importante por la relación entre ciertos tipos de cánceres y lesiones cardiovasculares con altos contenidos de metales. Los resultados obtenidos permiten deducir el buen estado global de las aguas
