Adverse outcomes after noncardiac surgery in patients with aortic stenosis

Abstract Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed prop...

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Autores principales:	Ying-Hsuan Tai, Chuen-Chau Chang, Chun-Chieh Yeh, Yih-Giun Cherng, Ta-Liang Chen, Chien-Chang Liao
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4099c08fd4594eb7a496295be789bebf
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spelling	oai:doaj.org-article:4099c08fd4594eb7a496295be789bebf2021-12-02T17:18:21ZAdverse outcomes after noncardiac surgery in patients with aortic stenosis10.1038/s41598-021-98507-62045-2322https://doaj.org/article/4099c08fd4594eb7a496295be789bebf2021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-98507-6https://doaj.org/toc/2045-2322Abstract Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.Ying-Hsuan TaiChuen-Chau ChangChun-Chieh YehYih-Giun CherngTa-Liang ChenChien-Chang LiaoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ying-Hsuan Tai Chuen-Chau Chang Chun-Chieh Yeh Yih-Giun Cherng Ta-Liang Chen Chien-Chang Liao Adverse outcomes after noncardiac surgery in patients with aortic stenosis
description	Abstract Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.
format	article
author	Ying-Hsuan Tai Chuen-Chau Chang Chun-Chieh Yeh Yih-Giun Cherng Ta-Liang Chen Chien-Chang Liao
author_facet	Ying-Hsuan Tai Chuen-Chau Chang Chun-Chieh Yeh Yih-Giun Cherng Ta-Liang Chen Chien-Chang Liao
author_sort	Ying-Hsuan Tai
title	Adverse outcomes after noncardiac surgery in patients with aortic stenosis
title_short	Adverse outcomes after noncardiac surgery in patients with aortic stenosis
title_full	Adverse outcomes after noncardiac surgery in patients with aortic stenosis
title_fullStr	Adverse outcomes after noncardiac surgery in patients with aortic stenosis
title_full_unstemmed	Adverse outcomes after noncardiac surgery in patients with aortic stenosis
title_sort	adverse outcomes after noncardiac surgery in patients with aortic stenosis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/4099c08fd4594eb7a496295be789bebf
work_keys_str_mv	AT yinghsuantai adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis AT chuenchauchang adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis AT chunchiehyeh adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis AT yihgiuncherng adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis AT taliangchen adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis AT chienchangliao adverseoutcomesafternoncardiacsurgeryinpatientswithaorticstenosis
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Adverse outcomes after noncardiac surgery in patients with aortic stenosis

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