The incidence and risk factors of perioperative cardiac complications in noncardiac major surgery in high-altitude areas: A prospective trial in Tibet autonomous region, China

Qianmei Zhu; Hanyu Duan; Zijia Liu; Yi Li; Yuelun Zhang; Labaciren; Le Shen; Yuguang Huang

doi:10.3389/fcvm.2023.1158711

The incidence and risk factors of perioperative cardiac complications in noncardiac major surgery in high-altitude areas: A prospective trial in Tibet autonomous region, China

Front Cardiovasc Med. 2023 Apr 3:10:1158711. doi: 10.3389/fcvm.2023.1158711. eCollection 2023.

Authors

Qianmei Zhu¹, Hanyu Duan², Zijia Liu¹, Yi Li², Yuelun Zhang³, Labaciren², Le Shen¹, Yuguang Huang¹

Affiliations

¹ Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Anesthesiology, Tibet Autonomous Region People's Hospital, Lhasa, China.
³ Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: The risk of perioperative cardiac complications (PCCs) in patients living in high-altitude areas may increase with more adverse clinical outcomes due to the special geographical environment, which has not yet been studied. We aimed to determine the incidence and analyze risk factors for PCCs in adult patients undergoing major noncardiac surgery in the Tibet Autonomous Region.

Methods: This prospective cohort study enrolled resident patients from high-altitude areas receiving major noncardiac surgery in Tibet Autonomous Region People's Hospital in China. Perioperative clinical data were collected, and the patients were followed up until 30 days after surgery. The primary outcome was PCCs during the operation and within 30 days after the surgery. Logistic regression was used to build the prediction models for PCCs. A receiver operating characteristic (ROC) curve was used to evaluate the discrimination. A prognostic nomogram was constructed to generate a numerical probability of PCCs for patients undergoing noncardiac surgery in high-altitude areas.

Results: Among the 196 patients living in high-altitude areas involved in this study, 33 (16.8%) suffered PCCs perioperatively and within 30 days after surgery. Eight clinical factors were identified in the prediction model, including older age (P = 0.028), extremely high altitude above 4,000 m (P = 0.442), preoperative metabolic equivalent (MET) < 4 (P = 0.153), history of angina within 6 months (P = 0.037), history of great vascular disease (P = 0.073), increased preoperative high sensitivity C-reactive protein (hs-CRP) (P = 0.072), intraoperative hypoxemia (P = 0.025) and operation time >3 h (P = 0.043). The area under the curve (AUC) was 0.766 (95% confidence interval: 0.785-0.697). The score calculated from the prognostic nomogram predicted the risk of PCCs in high-altitude areas.

Conclusion: The incidence of PCCs in resident patients living in high-altitude areas who underwent noncardiac surgery was high, and the risk factors included older age, high altitude above 4,000 m, preoperative MET < 4, history of angina within 6 months, history of great vascular disease, increased preoperative hs-CRP, intraoperative hypoxemia, and operation time >3 h. The prognostic nomogram of this study could help to assess the PCCs for patients in high-attitude areas undergoing noncardiac surgery.

Clinical trial registration: ClinicalTrials.gov ID: NCT04819698.

Keywords: Tibet autonomous region; high altitude; noncardiac surgery; perioperative cardiac complications; risk factor.

Associated data

ClinicalTrials.gov/NCT04819698

Grants and funding

This study was supported by a grant from the Tibet Natural Science Funding Committee [No. XZ2020ZR-ZYZ06 (z)] and the National High Level Hospital Clinical Research Funding of Peking Union Medical College Hospital (2022-PUMCH-B-007).