Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

Ali A Nasrallah; Habib A Dakik; Nassib F Abou Heidar; Jad A Najdi; Oussama G Nasrallah; Mazen Mansour; Hani Tamim; Albert El Hajj

doi:10.1177/17562872221084847

Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

Ther Adv Urol. 2022 Mar 18:14:17562872221084847. doi: 10.1177/17562872221084847. eCollection 2022 Jan-Dec.

Authors

Ali A Nasrallah¹, Habib A Dakik², Nassib F Abou Heidar¹, Jad A Najdi¹, Oussama G Nasrallah¹, Mazen Mansour¹, Hani Tamim³, Albert El Hajj⁴

Affiliations

¹ Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
² Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
³ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
⁴ Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon.

Abstract

Introduction: Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.

Methods: The cohort was derived from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer-Lemeshow test and compared to the RCRI and the AUB-HAS2 index.

Results: In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A₄CH model utilized six variables: Age ⩾75 years, ASA class >2, Anemia, surgical Approach, Creatinine >1.5, and history of Heart disease. Index ROC analysis provided a C-statistic of 0.81, calibration R ² was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively.

Conclusion: This study proposes a novel procedure-specific cardiovascular risk index. The PN-A₄CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.

Keywords: cardiovascular diseases; kidney neoplasm; logistic models; nephrectomy; nephron sparing surgery; postoperative complications.