Comprehensive Cardiac Surgery Risk Factors

Information on prespecified factors was obtained from PATS for the three centres. The presence of angina was grouped according to the Canadian Cardiovascular Society (CCS) categories: no angina, CCS 1 (ordinary activity does not cause angina); CCS 2 (slight limitation); CCS 3 (moderate limitation); or CCS 4 (inability to carry out any physical activity without discomfort). Dyspnoea was grouped according to the New York Heart Association (NYHA) functional classification: NYHA 1 (no symptoms and no limitation in ordinary physical activity); NHYA 2 (mild symptoms and slight limitation during ordinary activity); NYHA 3 (marked limitation in activity due to symptoms, comfortable only at rest); or NYHA 4 (severe limitations, experiences symptoms even while at rest). Previous myocardial infarction (MI) was categorised as; none; 1; or ≥2. Information was obtained on previous cardiac, vascular or thoracic surgery (0 and ≥1), the presence of diabetes, peripheral vascular disease, pulmonary disease, neurological disease, hypertension (treated or blood pressure (BP) >140/90) and preoperative haemoglobin (<10.0; 10.0 to 11.9; or ≥12.0 g/dL). Glomerular filtration rate (GFR) was estimated from the Cockcroft-Gault equation using the preoperative creatinine value obtained closest to the day of surgery, and grouped as: <30.0; 30.0 to 59.9; 60.0 to 89.9; or ≥90 μmol/L. Heparin or nitrates usage was grouped according to: none; within a week; or at operation. Any critical preoperative event was considered to be cardiogenic shock; preoperative intravenouse (IV) inotropes; or preoperative ventilation or intra-aortic balloon pump (IABP). The time between catheterisation and surgery was grouped as: within 24 hours; >24 hours for this admission; or >24 hours for a previous admission. Information was obtained on triple vessel disease, left main stem disease, ejection fraction (grouped as: good ≥50%; fair 30 to 49%; or poor <30%), operative priority (elective, urgent and emergency/salvage). Finally the cardiac procedures being undertaken were classified as coronary artery bypass graft surgery (CAGB) only; valve only; or CABG and valve and other/multiple. Procedures classed as other included major aortic surgery; left ventricular aneurysmectomy; atrial myxoma surgery; pulmonary embolectomy; epicardial pacemaker placement; pericardectomy; atrial septal defect closure; procedure for congenital conditions; acquired ventricular septal defect closure; pulmonary endarterectomy; atrial fibrillation ablation; myomectomy; cardiac surgery plus carotid endarterectomy or peripheral vascular procedures; or any other cardiothoracic procedure not listed above.

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Birnie K., Verheyden V., Pagano D., Bhabra M., Tilling K., Sterne J.A, & Murphy G.J. (2014). Predictive models for kidney disease: improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery. Critical Care, 18(6), 606.

Publication 2014

Angina Aortic Atrial Atrial fibrillation Atrial septal defect Blood pressure Cabg Cardiac Cardiac surgery Cardiogenic shock Cardiovascular Carotid endarterectomy Catheterisation Congenital conditions Creatinine Day surgery Diabetes Dyspnoea Embolectomy Emergency Endarterectomy Glomerular filtration rate Haemoglobin Heparin Hypertension Inotropes Intra aortic balloon pump Left main disease Left ventricular Myocardial infarction Myomectomy Myxoma Neurological disease Nitrates Pacemaker Pericardectomy Peripheral vascular disease Pulmonary Pulmonary disease Stem Surgery Thoracic surgery Vascular Ventricular septal defect Vessel disease

Corresponding Organization :

Other organizations : University of Bristol, NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust

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Variable analysis

independent variables

Angina grouped according to Canadian Cardiovascular Society (CCS) categories
Dyspnoea grouped according to New York Heart Association (NYHA) functional classification
Previous myocardial infarction (MI) categorised as; none; 1; or ≥2
Previous cardiac, vascular or thoracic surgery (0 and ≥1)
Presence of diabetes, peripheral vascular disease, pulmonary disease, neurological disease, hypertension
Preoperative haemoglobin (<10.0; 10.0 to 11.9; or ≥12.0 g/dL)
Glomerular filtration rate (GFR) grouped as: <30.0; 30.0 to 59.9; 60.0 to 89.9; or ≥90 μmol/L
Heparin or nitrates usage grouped as: none; within a week; or at operation
Any critical preoperative event (cardiogenic shock; preoperative intravenouse (IV) inotropes; or preoperative ventilation or intra-aortic balloon pump (IABP))
Time between catheterisation and surgery grouped as: within 24 hours; >24 hours for this admission; or >24 hours for a previous admission
Triple vessel disease, left main stem disease
Ejection fraction grouped as: good ≥50%; fair 30 to 49%; or poor <30%
Operative priority (elective, urgent and emergency/salvage)
Cardiac procedures being undertaken classified as coronary artery bypass graft surgery (CAGB) only; valve only; or CABG and valve and other/multiple

dependent variables

Not explicitly mentioned

control variables

Not explicitly mentioned

Annotations

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