Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population.

ABSTRACT

BACKGROUND AND AIMS: Myocardial injury after non-cardiac surgery (MINS) is associated with high postoperative mortality. We sought to examine the intraoperative variables associated with MINS among high-risk patients undergoing abdominal surgery at a South Indian Centre. METHODS: A retrospective analysis of patients who underwent abdominal surgery, aged >45 years with one of five factors hypertension, diabetes mellitus, previous coronary artery disease (CAD), stroke, or peripheral vascular disease or all patients >65 years of age was undertaken. Forty-six patients with raised troponin Group P (Trop I > 0.03 ng/d) were compared with 125 troponin-negative patients Group N (Trop I < 0.012 ng/dL) as well as 51 with intermediate levels Group I (Trop I > 0.012 and < 0.03 ng/dL). We evaluated the association of pre and intraoperative factors on MINS using logistic regression to identify the explanatory variables. RESULTS: Demographics were similar among the three groups. In-hospital mortality was significantly higher in group P (P = 0.005).The use of vasopressors (OR 2.6; 95% CI 1.2-5.5), female gender, (OR 2.3; 95%CI 1.1-4.7), associated CAD (OR 2.8;95% CI 1.1-7.4), and fresh frozen plasma (FFP) transfusion (OR 12.1;95% CI 1.3-11.7) were associated with MINS in regression analysis between group P versus group N. Female gender (OR2.3; 95% CI 1.2-4.5), postoperative mechanical ventilation (OR 3.5; 95% CI 1.2-10.4), and perioperative hypothermia (OR 4.5; 95% CI 1.3-14.9) were significant between Group P and Group I with Group N. CONCLUSIONS: Female patients with CAD undergoing abdominal surgery, needing vasopressors and transfusion of plasma are at high risk for MINS with higher hospital mortality and merit vigilant monitoring postoperatively.