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Predicting major adverse cardiac events in spine fusion patients: Is the revised cardiac risk index sufficient?

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dc.contributor.author Carabini L.M.
dc.contributor.author Zeeni C.
dc.contributor.author Moreland N.C.
dc.contributor.author Gould R.W.
dc.contributor.author Hemmer L.B.
dc.contributor.author Bebawy J.F.
dc.contributor.author Koski T.R.
dc.contributor.author McClendon J.
dc.contributor.author Koht A.
dc.contributor.author Gupta D.K.
dc.contributor.editor
dc.date 2014
dc.date.accessioned 2017-10-05T15:29:15Z
dc.date.available 2017-10-05T15:29:15Z
dc.date.issued 2014
dc.identifier 10.1097/BRS.0000000000000405
dc.identifier.isbn
dc.identifier.issn 03622436
dc.identifier.uri http://hdl.handle.net/10938/15172
dc.description.abstract STUDY DESIGN.: Observational cohort study. OBJECTIVE.: To determine the accuracy of the Revised Cardiac Risk Index (RCRI) in predicting major adverse cardiac events in patients undergoing spine fusion surgery of 3 levels or more. SUMMARY OF BACKGROUND DATA.: Preoperative cardiac testing is extensively guided by the RCRI, which was developed and validated in thoracic, abdominal, and orthopedic surgical patients. Because multilevel spine fusion surgery is often associated with major transfusion, we hypothesize that the RCRI may not accurately characterize the risk of cardiovascular morbidity in these patients. METHODS.: After institutional review board approval, perioperative data were collected from 547 patients who underwent 3 or more levels of spinal fusion with instrumentation. Postoperative cardiac morbidity was defined as any combination of the following: arrhythmia requiring medical treatment, myocardial infarction (either by electrocardiographic changes or troponin elevation), or the occurrence of demand ischemia. The surgical complexity was categorized as anterior surgery only, posterior cervical and-or thoracic fusion, posterior lumbar fusion, or any surgery that included transpedicular osteotomies. Logistic regression analysis was performed to determine RCRI performance. RESULTS.: The RCRI performed no better than chance (area under the curve = 0.54) in identifying the 49 patients (9percent) who experienced cardiac morbidity. CONCLUSION.: The RCRI did not predict cardiac morbidity in our patients undergoing major spine fusion surgery, despite being extensively validated in low-risk noncardiac surgical patients. Preoperative testing and optimization decisions, previously based on the RCRI, may need to be revised to include more frequent functional cardiac imaging and more aggressive implementation of pharmacologic modalities that may mitigate cardiac morbidity, similar to the preoperative evaluation for major vascular surgery. © 2014, Lippincott Williams and Wilkins.
dc.format.extent
dc.format.extent Pages: (1441-1448)
dc.language English
dc.publisher Lippincott Williams and Wilkins; PHILADELPHIA
dc.relation.ispartof Publication Name: Spine; Publication Year: 2014; Volume: 39; no. 17; Pages: (1441-1448);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title Predicting major adverse cardiac events in spine fusion patients: Is the revised cardiac risk index sufficient?
dc.type Article
dc.contributor.affiliation Carabini, L.M., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States
dc.contributor.affiliation Zeeni, C., Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation Moreland, N.C., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States
dc.contributor.affiliation Gould, R.W., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States
dc.contributor.affiliation Hemmer, L.B., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.affiliation Bebawy, J.F., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.affiliation Koski, T.R., Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.affiliation McClendon, J., Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.affiliation Koht, A., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.affiliation Gupta, D.K., Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
dc.contributor.authorAddress Gupta, D.K.; Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, 251 East Huron St #5-704, Chicago, IL 60611, United States; email: dhanesh-gupta@northwestern.edu
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Anesthesiology;
dc.contributor.authorDepartment Anesthesiology
dc.contributor.authorDivision
dc.contributor.authorEmail dhanesh-gupta@northwestern.edu
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Carabini, LM
dc.contributor.authorInitials Zeeni, C
dc.contributor.authorInitials Moreland, NC
dc.contributor.authorInitials Gould, RW
dc.contributor.authorInitials Hemmer, LB
dc.contributor.authorInitials Bebawy, JF
dc.contributor.authorInitials Koski, TR
dc.contributor.authorInitials McClendon, J
dc.contributor.authorInitials Koht, A
dc.contributor.authorInitials Gupta, DK
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Gupta, DK (reprint author), Northwestern Univ, Feinberg Sch Med, Dept Anesthesiol, 251 East Huron St 5-704, Chicago, IL 60611 USA.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
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dc.description.citedCount
dc.description.citedTotWOSCount 0
dc.description.citedWOSCount 0
dc.format.extentCount 8
dc.identifier.articleNo
dc.identifier.coden SPIND
dc.identifier.pubmedID
dc.identifier.scopusID 84905438168
dc.identifier.url
dc.publisher.address 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA
dc.relation.ispartofConference
dc.relation.ispartofConferenceCode
dc.relation.ispartofConferenceDate
dc.relation.ispartofConferenceHosting
dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
dc.relation.ispartofFundingAgency
dc.relation.ispartOfISOAbbr SPINE
dc.relation.ispartOfIssue 17
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle Spine
dc.relation.ispartofPubTitleAbbr Spine
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 39
dc.source.ID WOS:000341017600022
dc.type.publication Journal
dc.subject.otherAuthKeyword acute myocardial infarction
dc.subject.otherAuthKeyword acute myocardial ischemia
dc.subject.otherAuthKeyword cardiac events
dc.subject.otherAuthKeyword perioperative cardiac morbidity
dc.subject.otherAuthKeyword perioperative mortality
dc.subject.otherAuthKeyword preoperative assessment
dc.subject.otherAuthKeyword preoperative cardiac risk assessment
dc.subject.otherAuthKeyword preoperative cardiac testing
dc.subject.otherAuthKeyword preoperative risk
dc.subject.otherAuthKeyword spine fusion
dc.subject.otherAuthKeyword
dc.subject.otherChemCAS
dc.subject.otherIndex troponin
dc.subject.otherIndex article
dc.subject.otherIndex cardiovascular risk
dc.subject.otherIndex cohort analysis
dc.subject.otherIndex electrocardiography
dc.subject.otherIndex heart arrhythmia
dc.subject.otherIndex heart disease
dc.subject.otherIndex heart infarction
dc.subject.otherIndex heart muscle ischemia
dc.subject.otherIndex human
dc.subject.otherIndex informed consent
dc.subject.otherIndex ischemia
dc.subject.otherIndex major clinical study
dc.subject.otherIndex morbidity
dc.subject.otherIndex non ST segment elevation myocardial infarction
dc.subject.otherIndex observational study
dc.subject.otherIndex osteotomy
dc.subject.otherIndex postoperative period
dc.subject.otherIndex prediction
dc.subject.otherIndex preoperative period
dc.subject.otherIndex priority journal
dc.subject.otherIndex spine fusion
dc.subject.otherIndex spine surgery
dc.subject.otherIndex ST segment elevation myocardial infarction
dc.subject.otherIndex surgical patient
dc.subject.otherKeywordPlus TROPONIN-T RELEASE
dc.subject.otherKeywordPlus NONCARDIAC SURGERY
dc.subject.otherKeywordPlus VASCULAR-SURGERY
dc.subject.otherKeywordPlus MYOCARDIAL-INFARCTION
dc.subject.otherKeywordPlus RISK INDEX
dc.subject.otherKeywordPlus PROGNOSTIC-SIGNIFICANCE
dc.subject.otherKeywordPlus ORTHOPEDIC-SURGERY
dc.subject.otherKeywordPlus OLDER PATIENTS
dc.subject.otherKeywordPlus HEART-DISEASE
dc.subject.otherKeywordPlus HIP FRACTURE
dc.subject.otherWOS Clinical Neurology
dc.subject.otherWOS Orthopedics


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