Objectives Accumulating evidence correlates myocardial injury after noncardiac surgery(MINS), even when asymptomatic, with increased cardiac and non-cardiac morbidity and mortality. There is no literature on MINS specific to Gynecologic Oncology. We sought to evaluate the incidence and risk factors of MINS in patients aged ≥70.
Methods Elective laparotomies between 01/2016–09/2020 for patients aged≥70 at a tertiary hospital in ON, Canada, were reviewed using prospectively-collected National Surgical Quality Improvement Program(NSQIP) data. MINS was defined as peak serum high-sensitivity troponin-T concentration≥0.04ng/mL within 30 days postoperatively. Logistic regression analysis was performed.
Results In this cohort of 258 patients, of 242(93.8%) who underwent postoperative troponin screening, 40(16.5%) experienced MINS without exhibiting ischemic symptoms or ECG changes. The diagnosis of MINS led to a change in cardiovascular medications for 35 patients(87.5%). On univariate analysis, Revised Cardiac Risk Index(RCRI) of 3–5(p=0.002), history of coronary artery disease(p=0.003) or insulin-dependent diabetes(p=0.006), preoperative use of antiplatelets(p=0.009), beta-blockers(p=0.02), ACE-inhibitors(ACEI) or angiotensin-receptor blockers(ARB)(p=0.020) and frailty as defined by the NSQIP modified frailty index-5(p=0.02), were associated with greater risk of MINS. Factors reflecting surgical complexity including surgical complexity score, operative duration, blood loss and advanced oncologic stage, were not predictive. Multivariable analysis using backward selection procedure identified elevated RCRI and preoperative ACE/ARB as significant risk factors(OR5.93,95%CI 1.52–23.31,p=0.01 and OR2.3,95%CI 1.18–5.06,p=0.02).
Conclusions One in 6 patients in our cohort experienced asymptomatic MINS, irrespective of surgical complexity. MINS may be underdiagnosed after Gynecologic Oncology surgery in the absence of systematic troponin screening. Our analysis highlights a possible opportunity to optimize cardiac risk factors and potentially reduce morbidity and mortality.
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