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Open Access Research article

Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class

Luigi Vetrugno2*, Nicola Langiano2, Renato Gisonni3, Alessandro Rizzardo2, Paola Enrica Venchiarutti3, Michele Divella2, Livia Pompei2, Araldo Causero1 and Giorgio Della Rocca1

Author Affiliations

1 Dipartimento di Scienze Mediche Sperimentali e Cliniche, Università degli Studi di Udine, P.le Kolbe 3, ZIP code: 33100 Udine, Italy

2 Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, P.le S. M. della Misericordia 15, ZIP code: 33100 Udine, Italy

3 Department of Orthopedic Surgery, University-Hospital of Udine, P.le S. M. della Misericordia 15, ZIP code: 33100 Udine, Italy

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BMC Anesthesiology 2014, 14:20  doi:10.1186/1471-2253-14-20

Published: 21 March 2014

Abstract

Background

The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date.

Methods

The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge.

Results

MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point ≥ 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point ≥ 69 pg/mL gave an AUC of 0.82.

Conclusions

Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.

Keywords:
Brain natriuretic peptide; Orthopedic surgery; Preoperative care