Predictive risk factors for adverse events during tooth extraction among elderly patients with cardiovascular diseases

Abstract

Background: Tooth extraction is a risk factor for cardiovascular events, particularly in elderly patients. However, no clinical tool has been developed to date to predict the risk of adverse events (AEs) during tooth extraction.

Materials and methods: We prospectively enrolled 774 elderly patients (aged ≥ 60 years) with cardiovascular disease (CVD) who were scheduled to undergo tooth extraction at the dental surgery department of Shanghai Ninth People's Hospital from January 2021 to July 2022. To determine the predictive risk factors for AEs, we collected and recorded 62 factors on general characteristics, clinical information, physical and imaging examinations, psychological tests, perioperative characteristics, and surgical characteristics.

Results: We used a univariate logistic regression model to explore the 62 potential risk factors and included 21 factors in a multivariate model (all P-values < 0.05). After stepwise selection, 11 factors, including age, systolic blood pressure, severe hypertension, history of pacemaker use, stroke, ejection fraction, valvular insufficiency, atrial premature beats, ventricular premature beats, extraction of more than one tooth and the General Health Questionnaire-28 score, were included in the predictive model (all P-values < 0.05). In the test group, the area under the curve was 0.893 (0.866, 0.919), sensitivity was 0.878 (0.827, 0.93), specificity was 0.735 (0.697, 0.773) and accuracy was 0.768 (0.736, 0.800). In the validation group, these values were 0.857 (0.760, 0.954), 0.938 (0.819, 1.056) and 0.524 (0.417, 0.631), respectively. We created a nomogram to predict the risk factors for AEs during tooth extraction. Mental status plays a critical role in the risk of adverse effects, and the blood pressure also has a key influence on the prediction of adverse effects.

Conclusions: We developed and validated a predictive model with 11 clinical factors for the AEs during tooth extraction in elderly patients with CVD with well efficiency.

Keywords: Cardiovascular diseases; adverse event; elderly; risk factors; tooth extraction.

Figure 1.

ROC curves for three predictive models for the risk of adverse events during tooth extraction among elderly patients with cardiovascular diseases in the test group (a) and validation group (b). Test group: model 2 vs. model 1 (P-value = 0.2221), model 3 vs. model 1 (P-value = 0.1519). Validation group: model 2 vs. model 1 (P-value = 0.5982), model 3 vs. model 1 (P-value = 0.6435).

Figure 2.

Nomogram for the predictive model for the risk of adverse events during tooth extraction among elderly patients with cardiovascular disease in the test group. The score scale is the score for each risk factor. The total score is the sum score of all 11 risk factors. The corresponding probability of the total score is the probability of developing adverse events during or within 7 days following tooth extraction.