DOI: https://doi.org/10.22141/2224-0586.5.92.2011.143236

Functional status as a predictor of cardiac complications after abdominal surgery in obese patients

S.I. Vorotyntsev

Abstract


Background. The correlation between preoperative functional state and postoperative complications is very well described in abdominal surgery in the elderly and in the surgery of the cervical spine. However, there is no such data for patients with obesity. The purpose of our study was to evaluate the incidence of cardiac complications after elective abdominal operations in obese patients and to determine whether the level of preoperative functional status is a predictor of their development. Materials and methods. In a retrospective and prospective study, an analysis of hospital postoperative cardiac complications was performed in 770 patients with body mass index > 30 kg/m2, who underwent surgeries on the abdominal organs and the anterior abdominal wall in 2007–2018. The incidence of cardiac complications was compared with values predicted by the Lee index (Revised Cardiac Risk Index — RCRI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculator. The correlation of these values with the baseline functional status of patients (independent, partially dependent, completely dependent, metabolic equivalent (MET) < 4, MET > 4) and type of surgical intervention (laparoscopy, laparotomy, superficial surgery) was determined. Statistical processing of the results was performed using Student’s t-test, Mann-Whitney U-test, χ2 criterion, Fisher’s exact criterion, regression analysis. Results. The predicted risk of cardiac complications by RCRI was 0.9 % [0.9; 6.6], and according to the ACS-NSQIP calculator — 0.4 % [0; 3.2] (p < 0.05). The incidence of myocardial infarction and cardiac arrest was zero and differed from the predicted one (p < 0.01), non-fatal cardiac complications were observed in 2.8–3.6 % of patients. More than 96 % of patients in the prospective study (n = 490) were functionally independent, had good functional capacity, and the incidence of cardiac complications was 2 %. In partially dependent patients, this value increased to 23.5 % (odds ratio (OR) 14.76; 95% confidence interval (CI) 4.09–53.32), and in patients with MET < 4 — up to 36.4 % (OR 17.45; 95% CI 4.73–64.33). Conclusions. In obese patients after elective surgery on the abdominal organs and anterior abdominal wall, the percentage of major cardiac complications is significantly lower than that of predicted by the RCRI and the ACS-NSQIP calculator. The partially dependent functional status of patients and MET < 4 are factors of increased risk of postoperative non-fatal cardiac complications.

Keywords


obesity; cardiac complications; functional status

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