Serum B-type natriuretic peptide levels (BNP) can be used as a predictor of complications in patients undergoing non-cardiac surgery: a prospective observational study.

OBJECTIVES: Worldwide, an estimated 10 million adults annually experience significant myocardial injury after non-cardiac surgery. Our aim is to assess whether preoperative and postoperative serum B-type natriuretic peptides levels (BNP) could be used as a predictor of postoperative complications in hypertensive and diabetic patients post non-cardiac surgery. DESIGN: Prospective observational study. SETTING: Single tertiary-care centre in northern India. PARTICIPANTS: This study included 260 adult participants with known hypertension and diabetes who were planned for elective non-cardiac surgery. INTERVENTIONS: A preoperative BNP level (baseline BNP) was measured within 24 hours of surgery and another postoperative BNP level was measured within 24 hours of surgery. MAIN OUTCOME MEASURES: The primary outcome was the change in BNP levels (delta BNP) between the postoperative and the preoperative BNP levels (baseline BNP) with respect to the baseline BNP and the development of postoperative complications within 30 days of surgery. RESULTS: The study established a correlation between delta BNP and baseline BNP (Pearson's correlation coefficient=0.60; p=0.01). Our study found an increased serum BNP both in the preoperative period and the postoperative period in the patient group that developed complications, respectively (152.02 pg/mL±106.56 vs 44.90 pg/mL±44.22; t=4.120; p≤0.001); (313.99 pg/mL±121.29 vs 83.95 pg/mL±70.19; t=7.73; p≤0.001). CONCLUSIONS: We found that an increased serum baseline and postoperative BNP is potentially important predictor for the development of postoperative complications. Serum BNP has the potential to emerge as a cost-effective test for risk-stratification for postoperative complications in patients undergoing non-cardiac surgery. It has promising prognostic advantages including modification of surgical procedures, deferral of surgery and the ability to tailor therapy postoperatively.

Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge.

INTRODUCTION: Splenic artery aneurysms are rare but clinically important entities because of their potential for life threatening rupture. They seldom exceed 3cms in size and only a few cases of giant splenic artery aneurysms (more than 10cm size) have been reported until now. PRESENTATION OF CASE: A 58yr old female presented with painless pulsatile progressively enlarging lump in left upper abdomen. Contrast enhanced computed tomography revealed a 10.6×10.38cm aneurysm arising from distal splenic artery along with a normal pancreas. Surgical treatment in form of complete excision of the aneurysm along with spleen and distal pancreas was performed. Gross examination showed an unruptured 12.7×11.8cm true aneurysm of distal splenic artery. Postoperative course was uneventful. DISCUSSION: Splenic artery aneurysms are discovered incidentally and the life time risk of rupture is 28% for giant aneurysms. Even with availability of less invasive procedures such as laproscopy or endovascular treatment, open surgery is mostly preferred. CONCLUSION: Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.