Modern approaches to projection and differentiated assessment of cardiovascular risks in surgery: review

Cover Page

Cite item

Full Text

Abstract

OBJECTIVE: Study modern approaches to projection and differentiated assessment of cardiovascular risks with extracardiac surgical interventions.

MATERIALS AND METHODS: The articles from scientometric database RSCI, PubMed and Scopus for 2005–2022 are analyzed. In total, 39 literary sources were selected; not less than 70% of which were published over the past 5 years. The works, published more than 5 years ago, were allowed to include in the literature review only in case if they were primary sources and highly informative. RESULTS: To predict perioperative risk there is currently a range of general validated scales that help to define patients with a high risk of death and development of complications. These algorithms were developed based on multivariate statistical analysis of a large number of studies and reflect the links between clinical, laboratory and instrumental indicators with perioperative cardiovascular risk and mortality.

DISCUSSION: Nowadays there is no opportunity to predict the risk of developing cardiovascular complications and death after surgical intervention with 100% probability. The majority of existing indices and scales has their drawbacks, but complement each other, and their use may significantly help in the decision-making process on patient management tactics. However, data acquired through these means should be considered and taken into account only in the general context of diagnostic process along with conventional diagnostic methods.

CONCLUSION: The assessment of patient’s medical status and cardiovascular risk is one of the major tasks in preoperative preparation, which solution requires improvement and standardization of step-by-step algorithms.

About the authors

K. S. Shulenin

Kirov Military Medical Academy

Author for correspondence.
Email: shulenink@mail.ru
ORCID iD: 0000-0002-3141-7111
SPIN-code: 8476–1052

Konstantin S. Shulenin — Dr. of Sci. (Med.), Associate Professor, Colonel of the Medical Service, Deputy Head of the Department of Naval Therapy

194044, St. Petersburg, Akademika Lebedeva str., 6

Russian Federation

D. V. Cherkashin

Kirov Military Medical Academy

Email: fake@neicon.ru
ORCID iD: 0000-0003-1363-6860
SPIN-code: 2781-9507

Dmitry V. Cherkashin — Dr. of Sci. (Med.), Professor, Honored Doctor of the Russian Federation, Colonel of the Medical Service, Head of the Department of Naval Therapy

194044, St. Petersburg, Akademika Lebedeva str., 6

Russian Federation

I. A. Soloviev

City Mariinsky Hospital

Email: ivsolov@yandex.ru
ORCID iD: 0000-0001-9646-9775
SPIN-code: 6703-4852

Ivan A. Soloviev — Dr. of Sci. (Med.), Professor, Deputy Chief Physician for Surgery

56, Liteyny Ave., 191014, St. Petersburg

Russian Federation

R. D. Kuchev

Kirov Military Medical Academy

Email: dag_vmrg@mail.ru
SPIN-code: 4454-7582

Rafiq D. Kuchev — Lecturer of the Department of Naval Surgery

194044, St. Petersburg, Akademika Lebedeva str., 6

Russian Federation

References

  1. Devereaux P., Sessler D. Cardiac complications in patients undergoing major noncardiac surgery // New England Journal of Medicine. 2015. Vol. 373, No. 23. Р. 2258–2269. doi: 10.1056/nejmra1502824.
  2. Котвицкая З.Т., Колотова Г.Б., Руднов В.А. и др. Интраоперационные факторы риска развития инфаркта миокарда при некардиохирургических вмешательствах // Вестник анестезиологии и реаниматологии. 2018. Т. 15, № 2. С. 32–37. doi: 10.21292/2078-5658-2018-15-2-32-37.
  3. Kristensen S., Knuuti J., Saraste A. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management // European Heart Journal. 2014. No 35. Р. 2383–2431. doi: 10.1093/eurheartj/ehu282.
  4. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between complications and death within 30 days after noncardiac surgery // Canadian Medical Association Journal. 2019. Vol. 191, No. 30. Р. E830-E837. doi: 10.1503/cmaj.190221.
  5. International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries // British Journal of Anaesthesia. 2016. Vol. 117, No. 5. Р. 601–609. doi: 10.1093/bja/aew316.
  6. Малкова М.И., Булашова О.В., Хазова Е.В. Персонифицированный подход к оценке периоперационного риска у пациентов с сердечно-сосудистой патологией в клинике неотложной помощи // Вестник современной клинической медицины. 2018. Т. 11, № 5. С. 62–68. doi: 10.20969/vskm.2018.11(5).62-68.
  7. Джиоева О.Н., Драпкина О.М. Послеоперационная фибрилляция предсердий как фактор риска сердечно-сосудистых осложнений при внесердечных хирургических вмешательствах // Кардиоваскулярная терапия и профилактика. 2020. Т. 19, № 4. С. 112–118. doi: 10.15829/1728-8800-2020-2540.
  8. Сумин А.Н. Подготовка пациента с сердечно-сосудистыми заболеваниями к плановым хирургическим вмешательствам при онкопатологии // Комплексные проблемы сердечно-сосудистых заболеваний. 2019. Т. 8, № 1. С. 123–133. doi: 10.17802/2306-1278-2019-8-1-123-133.
  9. Козлов И.А, Овезов А.М., Пивоварова А.А. Снижение риска периоперационных осложнений при кардиальной коморбидности // Вестник анестезиологии и реаниматологии. 2020. Т. 17, № 2. С. 38–48. doi: 10.21292/2078-5658-2020-17-2-38-48.
  10. Заболотских И.Б., Трембач Н.В. Пациенты высокого периоперационного риска: два подхода к стратификации // Вестник интенсивной терапии им. А. И. Салтанова. 2019. № 4. С. 34–46. doi: 10.21320/1818-474X-2019-4-34-46.
  11. Abeeleh M., Tareef T., Hani A. et al. Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement // Annals of Surgical Treatment and Research. 2017. Vol. 93, No. 2. P. 65–69. doi: 10.4174/astr.2017.93.2.65.
  12. Liew L., Teo W., Seet E. et al. Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery — a retrospective cohort study // BMC Surgery. 2020. Vol. 20, No. 11. Р. 1–10. doi: 10.1186/s12893-019-0654-x.
  13. Spence J., LeManach Y., Chan M. et al. Association between complications and death within 30 days after noncardiac surgery // Canadian Medical Association Journal. 2019. Vol. 191, No. 30. P. E830-E837. doi: 10.1503/cmaj.190221.
  14. Glance L.G., Lustik S.J., Hannan E.L. et al. The surgical mortality probability model // Annals of Surgery. 2012. Vol. 255, No. 4. Р. 696–702. doi: 10.1097/sla.0b013e31824b45af.
  15. Koo C., Hyder J., Wanderer J., Eikermann M. et al. A meta-analysis of the predictive accuracy of postoperative mortality using the American Society of Anesthesiologists’ Physical Status Classification System // World Journal of Surgery. 2014. Vol. 39, Nо. 1. P. 88–103. doi: 10.1007/s00268-014-2783-9.
  16. Copeland G., Jones D., Walters M. POSSUM: A scoring system for surgical audit // British Journal of Surgery. 1991. Vol. 78, No. 3. P. 355–360. doi: 10.1002/bjs.1800780327.
  17. Le Manach Y., Collins G., Rodseth R. et al. Preoperative score to predict postoperative mortality (POSPOM) // Anesthesiology. 2016. Vol. 124, No. 3. P. 570–579. doi: 10.1097/aln.0000000000000972
  18. Froehner M., Koch R., Hubler M. et al. Validation of the preoperative score to predict postoperative mortality in patients undergoing radical cystectomy // European Urology Focus. 2019. Vol. 5, No. 2. P. 197–200. doi: 10.1016/j.euf.2017.05.003.
  19. Bilimoria K., Liu Y., Paruch J. et al. Development and evaluation of the universal ACS NSQIP Surgical Risk Calculator: a decision aid and informed consent tool for patients and surgeons // Journal of the American College of Surgeons. 2013. Vol. 217, No. 5. Р. 833–842.e3. doi: 10.1016/j.jamcollsurg.2013.07.385
  20. Котова Д.П., Котов С.В., Гиляров М.Ю. и др. Использование прогностических шкал в оценке периоперационных осложнений в практике врача-терапевта // Кардиоваскулярная терапия и профилактика. 2018. Т. 17, № 2. С. 75– 80. doi: 10.15829/1728-8800-2018-2-75-80.
  21. Mureddu G. Current multivariate risk scores in patients undergoing non-cardiac surgery // Monaldi Archives for Chest Disease. 2017. Vol. 87, No. 2. Р. 16–20. doi: 10.4081/monaldi.2017.848.
  22. Dilaver N., Gwilym B., Preece R. et al. Systematic review and narrative synthesis of surgeons’ perception of postoperative outcomes and risk // BJS Open. 2020. Vol. 4, No. 1. Р. 16–26. doi: 10.1002/bjs5.50233.
  23. Goldman L., Caldera D.L., Nussbaum S.R. et al. Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures // New England Journal of Medicine. 1977. Vol. 297, No. 16. Р. 845–850. doi: 10.1056/nejm197710202971601.
  24. Detsky A.S., Abrams H.B., McLaughlin J.R. et al. Predicting cardiac complications in patients undergoing non-cardiac surgery // Journal of General Internal Medicine. 1986. Vol. 1, No. 4. Р. 211–219. doi: 10.1007/bf02596184.
  25. Lee T., Marcantonio E., Mangione C. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery // Circulation. 1999. Vol. 100, No. 10. Р. 1043–1049. doi: 10.1161/01.cir.100.10.1043.
  26. Davis C., Tait G., Carroll J. et al. The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients // Canadian Journal of Anesthesia. 2013. Vol. 60, No. 9. Р. 855–863. doi: 10.1007/s12630-013-9988-5.
  27. Gupta P., Gupta H., Sundaram A. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery // Circulation. 2011. Vol. 124, No. 4. Р. 381–387. doi: 10.1161/circulationaha.110.015701.
  28. Cohn S., Fernandez Ros N. Comparison of 4 cardiac risk calculators in predicting postoperative cardiac complications after noncardiac operations // The American Journal of Cardiology. 2018. Vol. 121, No. 1. Р. 125–130. doi: 10.1016/j.amjcard.2017.09.031.
  29. Fronczek J., Polok K., Devereaux P.J. et al. External validation of the Revised Cardiac Risk Index and National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest calculator in noncardiac vascular surgery // British Journal of Anaesthesia. 2019. Vol. 123, No. 4. Р. 421–429. doi: 10.1016/j.bja.2019.05.029.
  30. Bertges D., Neal D., Schanzer A. et al. The Vascular Quality Initiative Cardiac Risk Index for prediction of myocardial infarction after vascular surgery // Journal of Vascular Surgery. 2016. Vol. 64, No. 5. Р. 1411–1421.e4. doi: 10.1016/j.jvs.2016.04.045.
  31. Eslami M., Rybin D., Doros G., Farber A. An externally validated robust risk predictive model of adverse outcomes after carotid endarterectomy // Journal of Vascular Surgery. 2016. Vol. 63, No. 2. Р. 345–354. doi: 10.1016/j.jvs.2015.09.003.
  32. Alrezk R., Jackson N., Al Rezk M. et al. Derivation and validation of a Geriatric‐Sensitive Perioperative Cardiac Risk Index // Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 2017. Vol. 6, No. 11. Р. 1–10. doi: 10.1161/JAHA.117.006648.
  33. Мурашко С.С., Пасечник И.Н., Бернс С.А. Миокардиальное повреждение при некардиальной хирургии: трудности диагностики // Комплексные проблемы сердечно-сосудистых заболеваний. 2020. Т. 9, № 3. С. 59–68. doi: 10.17802/2306-1278-2020-9-3-59-68.
  34. Duceppe E., Parlow J., MacDonald P. et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery // Canadian Journal of Cardiology. 2017. Vol. 33, No. 1, рр. 17–32. doi: 10.1016/j.cjca.2016.09.008.
  35. De Hert S., Staender S., Fritsch G. et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery // European Journal of Anaesthesiology. 2018. Vol. 35, No. 6. Р. 407–465. doi: 10.1097/eja.0000000000000817.
  36. Smilowitz N., Berger J. Рerioperative cardiovascular risk assessment and management for noncardiac surgery // Journal of the American Medical Association. 2020. Vol. 324, No. 3. Р. 279–290. doi: 10.1001/jama.2020.7840.
  37. Halvorsen S., Mehilli J., Cassese S. et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery // European Heart Journal. 2022. Vol. 3, No. 39. P. 3826–3924. doi: 10.1093/eurheartj/ehac270.
  38. Самойленко В.В., Шевченко О.П. Эволюция представлений об оценке риска развития сердечно-сосудистых осложнений в периоперационном периоде // Терапевтический архив. 2014. Т. 86, № 4. С. 96–102.
  39. Цыганков К.А., Щеголев А.В., Лахин Р.Е. Оценка функционального состояния пациента в предоперационном периоде с помощью кардиореспираторной нагрузочной пробы и опросника Дюка // Вестник Российской Военномедицинской академии. 2016. Т. 54, № 2. С. 34–37.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies