Highlights
- •Pulmonary hypertension (PH) has been associated with worse postoperative outcomes.
- •A systematic review found 18 studies about PH and outcomes after noncardiac surgery.
- •PH was independently associated with a two-fold higher risk of postoperative death.
- •PH was associated with higher postoperative risk of cardiorespiratory morbidity.
Abstract
Background
Some studies suggest that patients with pulmonary hypertension (PH) may be at higher
risk of complications and death after noncardiac surgery. However, the magnitude of
these associations is unclear.
Objectives
To determine the associations between PH and adverse outcomes after noncardiac surgery.
Methods
We searched PUBMED and EMBASE for studies published from January 1970 to April 2022.
We included studies that reported the association between PH and one or more outcomes
of interest occurring after noncardiac surgery. Data were pooled using random-effects
models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated
with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I2=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis
(OR 4.02; 95% CI, 2.14-7.54; I2=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I2=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I2=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73–6.60;
I2=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81–3.12;
I2=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70–21.02; I2=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke
(OR 0.93; 95% CI, 0.88–0.98; I2=0%; 3 studies).
Conclusion
PH is a predictor of morbidity and mortality after noncardiac surgery. High quality
studies are needed to determine effective strategies for reducing postoperative complications
in this population.
Keywords
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References
- Increasing incidence and prevalence of world health organization groups 1 to 4 pulmonary hypertension: a population-based cohort study in ontario.Circ Cardiovasc Qual Outcomes. 2018; 11 (Canada.)e003973
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6e1000097
- Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes.Lancet. 2015; 385 (Suppl): S11
- 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119
- Haemodynamic definitions and updated clinical classification of pulmonary hypertension.European Respiratory Journal. 2019; 531801913
- Canadian cardiovascular society/canadian thoracic society position statement on pulmonary hypertension.Can J Cardiol. 2020; 36: 977-992
- Pulmonary arterial hypertension: baseline characteristics from the REVEAL Registry.Chest. 2010; 137: 376-387
- Pulmonary hypertension could be a risk for deep vein thrombosis in lower extremities after joint replacement surgery.Rev Assoc Med Bras (1992). 2019; 65: 946-950
- Primary and Revision Total Knee Arthroplasty in Patients With Pulmonary Hypertension: High Perioperative Mortality and Complications.J Arthroplasty. 2021; 36: 3760-3764
- Cochrane Handbook for Systematic Reviews of Interventions version 6.3.Cochrane, 2022
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
- Tools for assessing methodological quality or risk of bias in non-randomized studies.Cochrane Handbook for Systematic Reviews of Interventions. 5.1.0. Cochrane Collaboration, London2011
- Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Eur J Epidemiol. 2010; 25: 603-605
- Benzodiazepine Use and Risk of Dementia in the Elderly Population: A Systematic Review and Meta-Analysis.Neuroepidemiology. 2016; 47: 181-191
- GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
Version Version 5.3: The Cochrane Collaboration; 2014.
- Outcome of patients with pulmonary hypertension undergoing elective, non-cardiac surgery: a propensity-matched study.Chest. 2016; 150: 37A
- Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery.Respir Med. 2011; 105: 619-624
- Clinical outcomes in patients with pulmonary hypertension undergoing total hip arthroplasty.HSS J. 2014; 10: 131-135
- Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery.Br J Anaesth. 2007; 99: 184-190
- Postoperative Outcome in Patients with Pulmonary Hypertension Undergoing Elective Non-Cardiac Surgery.JNMA J Nepal Med Assoc. 2017; 56: 438-441
- Risk factors for pulmonary complications, including pulmonary embolism, after total knee arthroplasty (TKA) in elderly Koreans.Arch Gerontol Geriatr. 2010; 51: 299-303
- Cardiovascular outcomes of patients with pulmonary hypertension undergoing noncardiac surgery.Am J Cardiol. 2019; 123: 1532-1537
- The effect of pulmonary hypertension on inpatient outcomes of laparoscopic procedures.Updates Surg. 2018; 70: 521-528
- The impact of pulmonary hypertension on morbidity and mortality following major lung resection.Eur J Cardiothorac Surg. 2014; 45: 1028-1033
- Routine preoperative resting echocardiography does not predict adverse cardiopulmonary events after bariatric surgery.Surg Obes Relat Dis. 2021; 17: 1133-1137
- Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement.Anesth Analg. 2010; 111: 1110-1116
- Abstract 12074: Perioperative Morbidity and Mortality in Patients with Pulmonary Hypertension Undergoing Noncardiac Surgery.Circulation. 2012; 126 (-A12074): A12074
- Influence of pulmonary hypertension on adverse outcomes following non-cardiac surgery.The Journal of Heart and Lung Transplantation. 2016; 35
- An unforgotten predictor of perioperative outcome in patients undergoing noncardiac surgery: Pulmonary hypertension.European Heart Journal. 2011; 32: 758
- Risks of postoperative respiratory failure in elderly patients after hip surgery: a retrospective study.J Orthop Surg Res. 2022; 17: 140
- Lung volume reduction surgery in selected patients with emphysema and pulmonary hypertension.Eur J Cardiothorac Surg. 2018; 54: 565-571
- Multidisciplinary perioperative management of pulmonary arterial hypertension in patients undergoing noncardiac surgery.South Med J. 2018; 111: 64-73
- Surgical intervention in patients with moderate to severe pulmonary arterial hypertension.Conn Med. 2006; 70: 239-243
- Focused review of perioperative care of patients with pulmonary hypertension and proposal of a perioperative pathway.Cureus. 2018; 10: e2072
- Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey.Eur Respir J. 2013; 41: 1302-1307
- Pulmonary hypertension and noncardiac surgery: implications for the anesthesiologist.J Cardiothorac Vasc Anesth. 2014; 28: 1064-1074
- [Pattern and causes of hemodynamic changes during hepatic resection].Medicina (Kaunas). 2010; 46: 760-766
- World health organization group I pulmonary hypertension: epidemiology and pathophysiology.Cardiol Clin. 2016; 34: 363-374
- Right ventricular function and perioperative risk assessment: the time has come to stop being sinister.J Cardiothorac Vasc Anesth. 2019; 33: 1287-1289
- Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.J Am Coll Surg. 2013; 217 (e331): 336-346
- Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.Ann Intern Med. 2010; 152: 26-35
- Development and validation of a risk calculator for prediction of cardiac risk after surgery.Circulation. 2011; 124: 381-387
- Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study.Ann Intern Med. 2020; 172: 96-104
- Outcomes After Noncardiac Surgery for Patients with Pulmonary Hypertension: A Historical Cohort Study.J Cardiothorac Vasc Anesth. 2020; 34: 1506-1513
- Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery.Can J Cardiol. 2017; 33: 17-32
- 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American college of cardiology/american heart association task force on practice guidelines.Circulation. 2014; 130: e278-e333
Article info
Publication history
Published online: November 04, 2022
Accepted:
October 21,
2022
Received in revised form:
October 20,
2022
Received:
August 31,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
