What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review
Bibliographic record
Abstract
BACKGROUND: Patients undergo cardiac preoperative evaluation to identify those at risk of adverse perioperative cardiac events. The Revised Cardiac Risk index is commonly used for this task, although it is unable to accurately risk stratify in all patients. This may be partly a result of intraoperative events which significantly modify preoperative risk. METHODS: We conducted a systematic review to identify independent intraoperative predictors of adverse cardiac events in patients undergoing non-cardiac surgery. Four databases (Ovid Healthstar 1966 to Jan 2012, Ovid Medline 1946 to 6 March 2012, EMBASE 1974 to March 05 2012 and The Cochrane Library to March 06 2012) were searched. RESULTS: Fourteen eligible studies were identified. The need for intraoperative blood transfusion (odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.3), vascular surgery (OR, 2.3; 95% CI, 1.2-3.4) and emergent/urgent surgery (OR, 2.3; 95% CI, 1.1-3.5) were the only independent intraoperative risk predictors identified in more than study. Other independent intraoperative factors identified included a >20 mmHg fall in mean arterial blood pressure for > 60 min (OR, 3.0; 95% CI, 1.8-4.9), >30% increase in baseline systolic pressure (OR, 8.0; 95% CI, 1.3-50), tachycardia in the recovery room (>30 beats per min (bpm) from baseline for >5 min) (OR, 7; 95% CI, 1.9-26), new onset atrial fibrillation (OR, 6.6; 95% CI, 2.5-20), hypothermia (OR, 2.2; 95% CI, 1.1-5) and remote ischemic preconditioning (OR, 0.22; 95% CI, 0.07-0.67). Other markers of surgical complexity were not independently associated with postoperative adverse cardiac outcomes. None of these studies controlled for blood transfusion. CONCLUSIONS: Intraoperative events significantly increase the risk for postoperative cardiac complications, although only intraoperative blood transfusion has strong evidence supporting this finding. It is possible that modification of these intraoperative risk factors by anesthetists and surgeons may reduce postoperative cardiac events and improve outcome. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study will add important information to understanding intraoperative risk factors for adverse cardiac events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.083 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.012 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".