Cancer and the Risk of Perioperative Arterial Ischemic Events.

Navi, Babak B; Zhang, Cenai; Kaiser, Jed H; Liao, Vanessa; Cushman, Mary; Kasner, Scott E; Elkind, Mitchell S V; Tagawa, Scott T; Guntupalli, Saketh R; Gaudino, Mario F L; Lee, Agnes Y Y; Khorana, Alok A; Kamel, Hooman

Navi, Babak B; Zhang, Cenai; Kaiser, Jed H; Liao, Vanessa; Cushman, Mary; Kasner, Scott E; Elkind, Mitchell S V; Tagawa, Scott T; Guntupalli, Saketh R; Gaudino, Mario F L; Lee, Agnes Y Y; Khorana, Alok A; Kamel, Hooman.

Afiliação

Navi BB; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
Zhang C; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY.
Kaiser JH; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
Liao V; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
Cushman M; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
Kasner SE; Division of Hematology and Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT.
Elkind MSV; Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Tagawa ST; Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Guntupalli SR; Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY.
Gaudino MFL; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora, CO.
Lee AYY; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Khorana AA; Division of Hematology, Department of Medicine, University of British Columbia, BC Cancer, Vancouver, BC.
Kamel H; Department of Hematology and Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH.

Eur Heart J Qual Care Clin Outcomes ; 2023 Sep 26.

Article em En | MEDLINE | ID: mdl-37757472

ABSTRACT

ABSTRACT

BACKGROUND AND

AIMS:

Most cancer patients require surgery for diagnosis and treatment. This study evaluated whether cancer is a risk factor for perioperative arterial ischemic events.

METHODS:

The primary cohort included patients registered in the National Surgical Quality Improvement Program (NSQIP) between 2006-2016. The secondary cohort included Healthcare Cost and Utilization Project (HCUP) claims data from 11 U.S. states between 2016-2018. Study populations comprised patients who underwent inpatient (NSQIP, HCUP) or outpatient (NSQIP) surgery. Study exposures were disseminated cancer (NSQIP) and all cancers (HCUP). The primary outcome was a perioperative arterial ischemic event, defined as myocardial infarction or stroke diagnosed within 30 days after surgery.

RESULTS:

Among 5,609,675 NSQIP surgeries, 2.2% involved patients with disseminated cancer. The perioperative arterial ischemic event rate was 0.96% among patients with disseminated cancer versus 0.48% among patients without (HR, 2.01; 95% CI, 1.90-2.13). In Cox analyses adjusting for demographics, functional status, comorbidities, surgical specialty, anesthesia type, and clinical factors, disseminated cancer remained associated with higher risk of perioperative arterial ischemic events (HR, 1.37; 95% CI, 1.28-1.46). Among 1,341,658 surgical patients in the HCUP cohort, 11.8% had a diagnosis of cancer. A perioperative arterial ischemic event was diagnosed in 0.74% of patients with cancer versus 0.54% of patients without cancer (HR, 1.35; 95% CI, 1.27-1.43). In Cox analyses adjusted for demographics, insurance, comorbidities, and surgery type, cancer remained associated with higher risk of perioperative arterial ischemic events (HR, 1.31; 95% CI, 1.21-1.42).