| Title: |
Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies |
| Authors: |
Ackland, GL; Abbott, TEF; Minto, G; Clark, M; Owen, T; Prabhu, P; May, SM; Reynolds, JA; Cuthbertson, BH; Wijesundera, D; Pearse, RM; Myles, PS; Shulman, MA; Wallace, S; Farrington, C; Thompson, B; Ellis, M; Borg, B; Kerridge, RK; Douglas, J; Brannan, J; Pretto, J; Godsall, MG; Beauchamp, N; Allen, S; Kennedy, A; Wright, E; Malherbe, J; Ismail, H; Riedel, B; Melville, A; Sivakumar, H; Murmane, A; Kenchington, K; Kirabiyik, Y; Gurunathan, U; Stonell, C; Brunello, K; Steele, K; Tronstad, O; Masel, P; Dent, A; Smith, E; Bodger, A; Abolfathi, M; Sivalingam, P; Hall, A; Painter, TW; Macklin, S; Elliott, A; Carrera, AM; Terblanche, NCS; Pitt, S; Samuels, J; Wilde, C; Leslie, K; MacCormick, A; Bramley, D; Southcott, AM; Grant, J; Taylor, H; Bates, S; Towns, M; Tippett, A; Marshall, F; Mazer, CD; Kunasingam, J; Yagnik, A; Crescini, C; Yagnik, S; McCartney, CJL; Choi, S; Somascanthan, P; Flores, K; Wijeysundera, DN; Beattie, WS; Karkouti, K; Clarke, HA; Jerath, A; McCluskey, SA; Wasowicz, M; Granton, JT; Day, L; Pazmino-Canizares, J; Oh, P; Belliard, R; Lee, L; Dobson, K; Chan, V; Brull, R; Ami, N; Stanbrook, M; Hagen, K; Campbell, D; Short, T; Van Der Westhuizen, J; Higgie, K; Lindsay, H; Jang, R; Wong, C; Mcallister, D; Ali, M; Kumar, J; Waymouth, E; Kim, C; Dimech, J; Lorimer, M; Tai, J; Miller, R; Sara, R; Collingwood, A; Olliff, S; Gabriel, S; Houston, H; Dalley, P; Hurford, S; Hunt, A; Andrews, L; Navarra, L; Jason-Smith, A; Thompson, H; McMillan, N; Back, G; Croal, BL; Lum, M; Martin, D; James, S; Filipe, H; Pinto, M; Kynaston, S; Phull, M; Beilstein, C; Bodger, P; Everingham, K; Hu, Y; Niebrzegowska, E; Corriea, C; Creary, T; Januszewska, M; Ahmad, T; Whalley, J; Haslop, R; McNeil, J; Brown, A; MacDonald, N; Pakats, M; Greaves, K; Jhanji, S; Raobaikady, R; Black, E; Rooms, M; Lawrence, H; Koutra, M; Pirie, K; Gertsman, M; Jack, S; Celinski, M; Levett, D; Edwards, M; Salmon, K; Bolger, C; Loughney, L; Seaward, L; Collins, H; Tyrell, B; Tantony, N; Golder, K; Stephens, RCM; Gallego-Paredes, L; Reyes, A; del Arroyo, AG; Raj, A; Lifford, R; King, A; Pollak, C; Williams, C; Patrick, A; West, C; Vickers, E; Green, R; Jones, A; Otto, J; Lach, A; Whittle, J; Paredes, LG; Toner, A; Williams, A; Pradhu, P; Hull, D; Montague, L |
| Contributors: |
Bianchi, C |
| Publisher Information: |
PUBLIC LIBRARY SCIENCE |
| Publication Year: |
2019 |
| Collection: |
The University of Melbourne: Digital Repository |
| Description: |
BACKGROUND: Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. METHODS: In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR ≤ 12 beats min-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). RESULTS: 882/1941 (45.4%) patients had HRR≤12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR≤12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR≤12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
1932-6203 |
| Relation: |
https://hdl.handle.net/11343/297067 |
| Availability: |
https://hdl.handle.net/11343/297067 |
| Rights: |
https://creativecommons.org/licenses/by/4.0 ; CC BY |
| Accession Number: |
edsbas.36996FA4 |
| Database: |
BASE |