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Multicenter Study
. 2021 Feb 16;10(4):e018013.
doi: 10.1161/JAHA.120.018013. Epub 2021 Jan 30.

Development and Validation of a Prediction Model for Stroke, Cardiac, and Mortality Risk After Non-Cardiac Surgery

Sang H Woo  1 , Gregary D Marhefka  2 , Scott W Cowan  3 , Lily Ackermann  1
Affiliations
Multicenter Study

Development and Validation of a Prediction Model for Stroke, Cardiac, and Mortality Risk After Non-Cardiac Surgery

Sang H Woo et al. J Am Heart Assoc. .

Abstract

Background Commonly used cardiovascular risk calculators do not provide risk estimation of stroke, a major postoperative complication with high morbidity and mortality. We developed and validated an accurate cardiovascular risk prediction tool for stroke, major cardiac complications (myocardial infarction or cardiac arrest), and mortality after non-cardiac surgery. Methods and Results This retrospective cohort study included 1 165 750 surgical patients over a 4-year period (2007-2010) from the American College of Surgeons National Surgical Quality Improvement Program Database. A predictive model was developed with the following preoperative conditions: age, history of coronary artery disease, history of stroke, emergency surgery, preoperative serum sodium (≤130 mEq/L, >146 mEq/L), creatinine >1.8 mg/dL, hematocrit ≤27%, American Society of Anesthesiologists physical status class, and type of surgery. The model was trained using American College of Surgeons National Surgical Quality Improvement Program data from 2007 to 2009 (n=809 880) and tested using data from 2010 (n=355 870). Risk models were developed using multivariate logistic regression. The outcomes were postoperative 30-day stroke, major cardiovascular events (myocardial infarction, cardiac arrest, or stroke), and 30-day mortality. Major cardiac complications occurred in 0.66% (n=5332) of patients (myocardial infarction, 0.28%; cardiac arrest, 0.41%), postoperative stroke in 0.25% (n=2005); 30-day mortality was 1.66% (n=13 484). The risk prediction model had high predictive accuracy with area under the receiver operating characteristic curve for stroke (training cohort=0.869, validation cohort=0.876), major cardiovascular events (training cohort=0.871, validation cohort=0.868), and 30-day mortality (training cohort=0.922, validation cohort=0.925). Surgery types, history of stroke, and coronary artery disease are significant risk factors for stroke and major cardiac complications. Conclusions Postoperative stroke, major cardiac complications, and 30-day mortality can be predicted with high accuracy using this web-based predictive model.

Keywords: myocardial infarction; prediction; stroke; surgery.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Forest plot and adjusted odds ratio of predictors for 30‐day postoperative stroke complication.
ASA indicates American Society of Anesthesiologists Physical Status Classification; ENT‐ear, nose, throat; and EVAR‐endovascular aneurysm repair.
Figure 2
Figure 2. Forest plot and adjusted odds ratio of predictors for 30‐day postoperative major cardiovascular complications (myocardial infarction, cardiac arrest, and/or stroke).
ASA indicates American Society of Anesthesiologists Physical Status Classification; ENT‐ear, nose, throat; and EVAR‐endovascular aneurysm repair.
Figure 3
Figure 3. Model performance (receiver operating characteristic curve) for stroke and 30‐day mortality in the validation group.
AUC indicates area under the receiver operating characteristic curve.
Figure 4
Figure 4. Mobile web‐based cardiac, stroke, mortality risk model.
MI indicates myocardial infarction.
See this image and copyright information in PMC

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