PERIOPERATIVE ANESTHETIC MANAGEMENT AND CARDIAC OUTCOMES: A MULTICENTER STUDY ON RISK STRATIFICATION IN HIGH-RISK CARDIOVASCULAR SURGICAL PATIENTS

Abstract

This multicenter observational cohort study aimed to evaluate the impact of perioperative anesthetic management on cardiac outcomes in high-risk cardiovascular surgical patients. A total of 1,200 adult patients undergoing elective or urgent cardiac surgeries were enrolled across five tertiary care centers. Preoperative variables, intraoperative monitoring strategies, and postoperative outcomes were meticulously analyzed. The average age of patients was 66.2 years and they often had diabetes mellitus (40.7%) and hypertension (77.3%).  Major adverse cardiac events (MACE) were reported in 15 percent of patients and 3 percent of all cases were deaths that happened after the procedure.  Age over 70 years, EuroSCORE II above 6, preoperative diabetes, intraoperative hypotension and postoperative acute renal damage were identified by multivariate logistic regression as main predictors of MACE.  By contrast, having cerebral oximetry used had a tendency to protect the patient (OR: 0.72; p=0.056).  When researchers used advanced anaesthetic methods, stratified study proved that combination intervention—goal-directed fluid management, use of cerebral oximetry and standard monitoring—showed the lowest MACE incidence (11.0%).  Furthermore, many cases showed intraoperative hypotension (30.3%) and made it clear that monitoring metabolism and nutrition is needed during the recovery process.  They suggest that extensive perioperative steps and several types of anaesthetic are needed to increase the success of cardiovascular surgeries.  Customised patient risk assessment and using precision monitoring are important, according to the study, to treat patients before surgery and prevent more cases of morbidity and death.