Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery - An observational study

Context Right heart catheterization (RHC) is commonly performed before high -risk noncardiac surgery, but the benefit: of this strategy remains unprove n. Objective To evaluate the relationship between use of perioperative RHC and postoperative cardiac complication rates in patients undergoing major nonc ardiac surgery. Design Prospective, observational cohort study. Setting Tertiary care teaching hospital in the United States. Patients Patients (n=4059 aged greater than or equal to 50 years) who under went major elective noncardiac procedures with an expected length of stay o f 2 or more days between July 18, 1989, and February 28, 1994, Two hundred twenty one patients had RHC and 3838 did not. Main Outcome Measure Combined end point of major postoperative cardiac even ts, including myocardial infarction, unstable angina, cardiogenic pulmonary edema, ventricular fibrillation, documented ventricular tachycardia or pri mary cardiac arrest, and sustained complete heart block, classified by a re viewer blinded to preoperative data. Results Major cardiac events occurred in 171 patients (4.2%). Patients who underwent perioperative RHC had a 3-fold increase in incidence of major pos toperative cardiac events (34 [15.4%] vs 137 [3.6%]; P<.001). In multivaria te analyses, the adjusted odds ratios (ORs) for postoperative major cardiac and noncardiac events in patients undergoing RHC were 2.0 (95% confidence interval [CI], 1.3-3.2) and 2.1 (95% CI, 1.2-3.5), respectively. In a case- control analysis of a subset of 215 matched pairs of patients who did and d id not undergo RHC, adjusted for propensity of RHC and type of procedure, p atients who underwent perioperative RHC also had increased risk of postoper ative congestive heart failure (OR, 2.9; 95% CI, 1.4-6.2) and major noncard iac events (OR, 2.2; 95% CI, 1.4-4.9). Conclusions No evidence was found of reduction in complication rates associ ated with use of perioperative RHC in this population. Because of the morbi dity and the high costs associated with RHC, the impact of this interventio n in perioperative care should be evaluated in randomized trials.