Hypothesis: Intrinsic cardiac risk varies among groups defined as homogenous previously
Methods: Data on approximately 3,000,000 patients from the ACS NSQIP database over a period of 5 years was evaluated using logistic regression analysis to control for patient characteristics and determine cardiac risks of each procedure.
Results: Surgical procedures were stratified into low, intermediate, and high-risk for cardiac complications. There were sixty-six procedures in the low-risk group, 30 in the intermediate-risk group, and 106 in the high-risk group. Excisional breast biopsy carried the lowest risk while aortobifemoral bypass grafting carried the highest risk.
Strengths: Very large database; good internal validity and generalizability in US; defined risk of specific procedures rather than “areas of the body”; decent attempt to control for confounders
Weaknesses: Retrospective nature sensitive to potential confounders; unclear clinical significance for some types of procedures; does not include risk from individual patient comorbidities; unable to draw conclusions about rarer procedures
Key Point: Provides a contemporary estimate of perioperative cardiac risks for many types of surgical procedures.