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dc.contributor.authorBeattie, W Scott-
dc.contributor.authorWijeysundera, Duminda N-
dc.contributor.authorChan, Matthew T V-
dc.contributor.authorPeyton, Philip J-
dc.contributor.authorLeslie, Kate-
dc.contributor.authorPaech, Michael J-
dc.contributor.authorSessler, Daniel I-
dc.contributor.authorWallace, Sophie-
dc.contributor.authorMyles, Paul S-
dc.contributor.authorGalagher, W-
dc.contributor.authorFarrington, C-
dc.contributor.authorDitoro, A-
dc.contributor.authorBaulch, S-
dc.contributor.authorSidiropoulos, Sofia-
dc.contributor.authorBulach, R-
dc.contributor.authorBryant, D-
dc.contributor.authorO'Loughlin, E-
dc.contributor.authorMitteregger, V-
dc.contributor.authorBolsin, S-
dc.contributor.authorOsborne, C-
dc.contributor.authorMcRae, R-
dc.contributor.authorBackstrom, M-
dc.contributor.authorCotter, R-
dc.contributor.authorMarch, S-
dc.contributor.authorSilbert, B-
dc.contributor.authorSaid, S-
dc.contributor.authorHalliwell, R-
dc.contributor.authorCope, J-
dc.contributor.authorFahlbusch, D-
dc.contributor.authorCrump, D-
dc.contributor.authorThompson, G-
dc.contributor.authorJefferies, A-
dc.contributor.authorReeves, M-
dc.contributor.authorBuckley, N-
dc.contributor.authorTidy, T-
dc.contributor.authorSchricker, T-
dc.contributor.authorLattermann, R-
dc.contributor.authorIannuzzi, D-
dc.contributor.authorCarroll, J-
dc.contributor.authorJacka, M-
dc.contributor.authorBryden, C-
dc.contributor.authorBadner, N-
dc.contributor.authorTsang, M W Y-
dc.contributor.authorCheng, B C P-
dc.contributor.authorFong, A C M-
dc.contributor.authorChu, L C Y-
dc.contributor.authorKoo, E G Y-
dc.contributor.authorMohd, N-
dc.contributor.authorMing, L E-
dc.contributor.authorCampbell, D-
dc.contributor.authorMcAllister, D-
dc.contributor.authorWalker, S-
dc.contributor.authorOlliff, S-
dc.contributor.authorKennedy, R-
dc.contributor.authorEldawlatly, A-
dc.contributor.authorAlzahrani, T-
dc.contributor.authorChua, N-
dc.contributor.authorSneyd, R-
dc.contributor.authorMcMillan, H-
dc.contributor.authorParkinson, I-
dc.contributor.authorBrennan, A-
dc.contributor.authorBalaji, P-
dc.contributor.authorNightingale, J-
dc.contributor.authorKunst, G-
dc.contributor.authorDickinson, M-
dc.contributor.authorSubramaniam, B-
dc.contributor.authorBanner-Godspeed, V-
dc.contributor.authorLiu, J-
dc.contributor.authorKurz, A-
dc.contributor.authorHesler, B-
dc.contributor.authorFu, A Y-
dc.contributor.authorEgan, C-
dc.contributor.authorFiffick, A N-
dc.contributor.authorHutcherson, M T-
dc.contributor.authorTuran, A-
dc.contributor.authorNaylor, A-
dc.contributor.authorObal, D-
dc.contributor.authorCooke, E-
dc.identifier.citationAnesthesia and analgesia 2018; 127(5): 1118-1126-
dc.description.abstractGlobally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.-
dc.titleImplication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.-
dc.typeJournal Article-
dc.identifier.journaltitleAnesthesia and analgesia-
dc.identifier.affiliationDepartments of Anesthesiaen
dc.identifier.affiliationDepartment of Anesthesia, University of Toronto, Toronto, Ontario, Canadaen
dc.identifier.affiliationAnesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canadaen
dc.identifier.affiliationLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canadaen
dc.identifier.affiliationFrom the Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canadaen
dc.identifier.affiliationDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australiaen
dc.identifier.affiliationSchool of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, Parkville, Victoria, Australiaen
dc.identifier.affiliationDepartment of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Surgery, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia, Austin Health, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China-
dc.identifier.affiliationDepartment of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio-
dc.type.austinComparative Study-
dc.type.austinJournal Article-
dc.type.austinMulticenter Study-
dc.type.austinRandomized Controlled Trial-
dc.type.austinResearch Support, Non-U.S. Gov't-
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