Impaired vascular endothelial function as a perioperative risk predictor - a prospective observational trial

Volker Schick; Marc Boensch; Milan van Edig; Jonas Alfitian; Tülay Pola; Hannes Ecker; Falko Lindacher; Kija Shah-Hosseini; Wolfgang A Wetsch; Bernhard Riedel; Robert Schier

doi:10.1186/s12871-021-01400-y

Impaired vascular endothelial function as a perioperative risk predictor - a prospective observational trial

BMC Anesthesiol. 2021 Jul 15;21(1):190. doi: 10.1186/s12871-021-01400-y.

Authors

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany. volker.schick@uk-koeln.de.
² Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
³ Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
⁴ Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and The University of Melbourne, Melbourne, Australia.

^# Contributed equally.

Abstract

Background: In the recent years, an increasing number of patients with multiple comorbidities (e.g. coronary artery disease, diabetes, hypertension) presents to the operating room. The clinical risk factors are accompanied by underlying vascular-endothelial dysfunction, which impairs microcirculation and may predispose to end-organ dysfunction and impaired postoperative outcome. Whether preoperative endothelial dysfunction identifies patients at risk of postoperative complications remains unclear. In this prospective observational study, we tested the hypothesis that impaired flow-mediated dilation (FMD), a non-invasive surrogate marker of endothelial function, correlates with Days at Home within 30 days after surgery (DAH30). DAH30 is a patient-centric metric that captures postoperative complications and importantly also hospital re-admissions.

Methods: Seventy-one patients scheduled for major abdominal surgery were enrolled. FMD was performed pre-operatively prior to major abdominal surgery and patients were dichotomised at a threshold value of 10%. FMD was then correlated with DAH30 (primary endpoint) and postoperative complications (secondary endpoints).

Results: DAH30 did not differ between patients with reduced FMD and normal FMD (14 (4) (median (IQR)) vs. 15 (8), P = 0.8). Similary, no differences between both groups were found for CCI (normal FMD: 21 (30) (median (IQR)), reduced FMD: 26 (38), P = 0.4) or frequency of major complications (normal FMD: 7 (19%) (n (%)), reduced FMD: 12 (35%), P = 0.12). The regression analyses revealed that FMD in combination with ASA status and surgery duration had no additional significant predictive effect for DAH30, CCI or Clavien-Dindo score.

Conclusion: FMD does not add predictive value with regards to DAH30, CCI or Clavien-Dindo score within our study cohort of patients undergoing abdominal surgery.

Trial registration: The study was registered in the German Clinical Trials Register ( DRKS00005472 ), prospectively registered on 25/11/2013.

Keywords: Flow mediated vasodilation; Impaired vascular endothelial function; Perioperative risk prediction.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Abdomen / surgery*
Aged
Cohort Studies
Endothelium, Vascular / pathology*
Female
Humans
Male
Middle Aged
Patient Readmission
Postoperative Complications / epidemiology*
Predictive Value of Tests
Prospective Studies
Risk Factors
Vasodilation / physiology*

Associated data

DRKS/DRKS00005472