Zimmerman et al evaluated the impact of preoperative myocardial injury and other factors on outcomes following emergency general surgery. The authors are from Brown University.
Patient selection: emergency general surgery
Criteria for myocardial injury: serum troponin greater than upper limit of normal reference range for institution (in study > 0.15 ng/ml).
An elevated serum troponin prior to surgery was associated with increased risk of mortality on multivariate analysis (OR 3.0). It was a weak predictor of postoperative event (OR 1.5, p 0.20). It was associated with acute renal failure and septic shock.
Other factors associated with postoperative events on univariate analysis:
(1) cancer (OR 9.5)
(2) ASA 3 or greater (OR 7.9)
(3) acute renal failure (OR 7.6)
(4) open wound (OR 6.1)
(5) functional dependency (OR 3.7)
(6) dialysis dependence (OR 3.6)
(7) sepsis (OR 3.5)
(8) steroid use (OR 2.9)
(9) weight loss (OR 2.9)
(10) CHF (OR 2.4)
(11) bleeding (OR 2.0)
(12) wound class dirty or infected (OR 1.8)
(13) ascites (OR 1.8
(14) COPD (OR 1.7)
(15) diabetes (OR 1.6)
Other factors associated with mortality on univariate analysis:
(1) ascites (OR 29.5)
(2) cancer (OR 7.6)
(3) CHF (OR 7.3)
(4) open wound (OR 4.9)
(5) sepsis (OR 4.5)
(6) functional dependency (OR 4.1)
(7) dialysis dependence (OR 3.8)
(8) acute renal failure (OR 2.5)
(9) bleeding (OR 2.0)
(10) morbid obesity (OR 1.8)
(11) age > 65 years (OR 1.7)
(12) COPD (OR 1.7)
(13) diabetes mellitus (OR 0.6)
