Department of Vascular Surgery and Angiology, St. John Grande Hospital, Kraków, Poland.
Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
Kardiol Pol. 2023;81(9):870-877. doi: 10.33963/KP.a2023.0153. Epub 2023 Jul 4.
Abdominal aortic aneurysms (AAAs) and peripheral artery disease significantly increase the risk of perioperative complications.
The study aimed to determine the incidence of myocardial injury after noncardiac surgery (MINS), its association with 30-day mortality, as well as predictors of postoperative acute kidney injury (pAKI) and bleeding independently associated with mortality (BIMS) in patients undergoing open vascular surgeries involving the abdominal aorta.
We performed a retrospective cohort study using a sample of consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and/or aortoiliac occlusive disease in a single tertiary center. In each patient, at least two postoperative troponin measurements were performed (on the first and second postoperative day). Creatinine and hemoglobin levels were measured preoperatively and at least twice postoperatively. The outcomes included MINS (primary outcome), pAKI, and BIMS (secondary outcomes). We assessed the associations between them and 30-day mortality and performed multivariable analysis to identify risk factors for these outcomes.
The study group comprised 553 patients. The mean age was 67.6 years, and 82.5% of patients were male. The incidence of MINS, pAKI, and BIMS was 43.8%, 17.2%, and 45.8%, respectively. The 30-day mortality rate was higher in patients who developed MINS (12.0% vs. 2.3%; P <0.001), pAKI (32.6% vs. 1.1%; P <0.001), or BIMS (12.3% vs. 1.7%; P <0.001) compared to patients who did not develop these complications.
This study demonstrated that MINS, pAKI, and BIMS are common complications after open aortic surgeries, and they are related to a substantial increase in the 30-day mortality rate.
腹主动脉瘤（AAA）和外周动脉疾病显著增加围手术期并发症的风险。
本研究旨在确定非心脏手术后心肌损伤（MINS）的发生率，以及其与 30 天死亡率的关系，以及与死亡率独立相关的术后急性肾损伤（pAKI）和出血（BIMS）的预测因子，这些预测因子在接受涉及腹主动脉的开放性血管手术的患者中。
我们使用来自单一三级中心的因肾下 AAA 和/或主髂动脉闭塞性疾病而接受开放性腹主动脉手术的连续患者样本进行回顾性队列研究。在每个患者中，至少进行了两次术后肌钙蛋白测量（在术后第 1 天和第 2 天）。在术前和至少两次术后测量了肌酐和血红蛋白水平。结果包括 MINS（主要结果）、pAKI 和 BIMS（次要结果）。我们评估了它们与 30 天死亡率之间的关联，并进行了多变量分析以确定这些结果的危险因素。
研究组包括 553 名患者。平均年龄为 67.6 岁，82.5%的患者为男性。MINS、pAKI 和 BIMS 的发生率分别为 43.8%、17.2%和 45.8%。发生 MINS（12.0%比 2.3%；P<0.001）、pAKI（32.6%比 1.1%；P<0.001）或 BIMS（12.3%比 1.7%；P<0.001）的患者 30 天死亡率更高。
本研究表明，MINS、pAKI 和 BIMS 是开放性主动脉手术后常见的并发症，与 30 天死亡率的显著增加有关。
