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Cited by 6Cardiac, Anesthesia and Surgical OutcomesHemodynamic Monitoring and TherapyFrailty in Older Adults

Postoperative mortality risk prediction that incorporates intraoperative vital signs: development and internal validation in a historical cohort

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Ke, Janny Xue Chen, McIsaac, Daniel I., George, Ronald B., Branco, Paula, Cook, E. Francis, Beattie, W. Scott, Urquhart, Robin, MacDonald, David B.·2022·Canadian Journal of Anesthesia/Journal canadien d'anesthésie
DOI 10.1007/s12630-022-02287-0
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Abstract

Purpose Accurate risk reassessment after surgery is crucial for postoperative planning for monitoring and disposition. Existing postoperative mortality risk prediction models using preoperative features do not incorporate intraoperative hemodynamic derangements that may alter risk stratification. Intraoperative vital signs may provide an objective and readily available prognostic resource. Our primary objective was to derive and internally validate a logistic regression (LR) model by adding intraoperative features to established preoperative predictors to predict 30-day postoperative mortality. Methods Following Research Ethics Board approval, we analyzed a historical cohort that included patients aged ≥ 45 undergoing noncardiac surgery with an overnight stay at two tertiary hospitals (2013 to 2017). Features included intraoperative vital signs (blood pressure, heart rate, end-tidal carbon dioxide partial pressure, oxygen saturation, and temperature) by threshold and duration of exposure, as well as patient, surgical, and anesthetic factors. The cohort was divided temporally 75:25 into derivation and validation sets. We constructed a multivariable LR model with 30-day all-cause mortality as the outcome and evaluated performance metrics. Results There were 30,619 patients in the cohort (mean [standard deviation] age, 66 [11] yr; 50.2% female; 2.0% mortality). In the validation set, the primary LR model showed a c-statistic of 0.893 (99% confidence interval [CI], 0.853 to 0.927), a Nagelkerke R-squared of 0.269, a scaled Brier score of 0.082, and an area under precision-recall curve of 0.158 (baseline 0.017 for an uninformative model). The addition of intraoperative vital signs to preoperative factors minimally improved discrimination and calibration. Conclusion We derived and internally validated a model that incorporated vital signs to improve risk stratification after surgery. Preoperative factors were strongly predictive of mortality risk, and intraoperative predictors only minimally improved discrimination. External and prospective validations are needed. Study registration www. Clinicaltrials gov (NCT04014010); registered on 10 July 2019.

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Authors
Ke, J. X. C., McIsaac, D. I., George, R. B., Branco, P., Cook, E. F., Beattie, W. S., Urquhart, R., & MacDonald, D. B.
Affiliations
  • Dalhousie University (CA)
  • University of Ottawa (CA)
  • Harvard University (US)
  • University of Toronto (CA)
Corresponding author
Ke, Janny Xue Chen
ORCID
Venue
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Publisher
Springer Science and Business Media LLC
Published
2022-08-22
Volume
69
Issue
9
Pages
1086-1098
ISSN
  • 0832-610X (ISSN-L)
  • 1496-8975
DOI
10.1007/s12630-022-02287-0
OpenAlex
W4292641730
Cited by
6
References
3
Citations by year
2026: 2 · 2024: 2 · 2023: 1 · 2022: 1
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Department of Anesthesia, Pain Management & Perioperative Medicine at Dalhousie University
  • Nova Scotia Health Authority Research Fund
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
postoperative mortality, risk prediction model, non-cardiac surgery, 30-day mortality, hemodynamic derangements, end-tidal carbon dioxide, blood pressure, heart rate, oxygen saturation, postoperative risk stratification, logistic regression
MeSH terms
Aged, Female, Humans, Male, Prognosis, Retrospective Studies, Risk Factors, Cohort Studies, Logistic Models, Risk Assessment, Vital Signs

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