patients undergoing major cancer surgery: incidence and predictive value for postoperative cardiac events

Conditions: High Risk for Postoperative Cardiovascular Events

Summary: the purpose of this study is to look at a new method for finding out if patients have a risk of heart complications from surgery. at the present, to find out if patients have a risk of heart complications from surgery, look at whether the patient has heart disease, diabetes, kidney problems, and stroke. the investigators hope that this study will confirm a new, safe test to help us predict the risk of surgery.


Eligibility criteria:
inclusion criteria: * age 50 or older * undergoing high risk cancer surgery (patient must be undergoing one of the following procedures note: all open or robotic forms of the following procedures meet the eligibility criteria. gmt/ hepatobiliary * pancreatic resection * retroperitoneal sarcomas * shoulder (forequarter) amputation * esophagectomy, esophagogastrectomy * pheochromocytoma * liver resection (with or without bile duct resection) orthopedics * spine resections (with or without spinal fusion) * metastatic disease requiring total hip replacement * total shoulder replacement / forequarter amputation * hemipelvectomy * sacrectomy thoracic * extrapleural pneumonectomy * pleurectomy and decortication * pneumonectomy * esophagogastrectomy * mediastinal tumor resection * pancoast tumor * completion pneumonectomy * lobectomy (post-induction chemotherapy; or severe copd) * segmentectomy colorectal/ gyn * colon resection with possible sacrectomy * pelvic exenteration * advanced ovarian cancer resection with or without liver resection urology * radical cystectomy * open radical prostatectomy * nephrectomy with vena caval resection head \& neck * thyroid resection with mediastinal involvement * major head and neck cancer resection with free flap reconstruction other * unclassified major surgery at the discretion of the pi * postoperative stay likely to be 2 or more days * patients willing to tolerate inflation of a blood pressure cuff for 5 minutes * patients willing to cut long nails in order to wear finger probe. * patients with one or more of the following rcri risk factors: * history of ischemic heart disease (any) * history of myocardial infarction * history of positive exercise test * current complaint of chest pain considered secondary to myocardial ischemia * use of nitrate therapy * ecg with pathological q waves * history of congestive heart failure (any) * history of congestive heart failure * pulmonary edema * paroxysmal nocturnal dyspnea * bilateral rales or s3 gallop * chest radiograph showing pulmonary vascular redistribution * history of cerebrovascular disease (any) * history of transient ischemic attack (tia) or stroke * preoperative treatment with insulin * preoperative serum creatinine \> 2.0 mg/dl * evidence of peripheral vascular disease other than cerebral vascular disease (although peripheral vascular disease is not strictly a rcri risk factor, fleisher indicates: "it would not be inappropriate to assume that any atherosclerotic class of disease is equivalent to ischemic heart disease for risk purposes." exclusion criteria: * medical conditions precluding use of arm blood pressure measurements such as prior lymphadenectomy, vascular shunts for dialysis or upper extremity occlusive vascular disease * patients undergoing emergency surgery * any of the following active conditions * unstable coronary syndromes * uncompensated heart failure; worsening or new onset chf * significant arrhythmias * atrial fibrillation, presently * high grade av block * symptomatic ventricular arrhythmias or new ventricular arrhythmias * supraventricular arrhythmias with poor rate control * symptomatic bradycardia * severe valvular disease * severe aortic stenosis (mean transvalvular gradient \>40mmhg) * symptomatic mitral stenosis * any other condition that at the judgment of the investigator might require additional evaluation and treatment before surgery.

Keywords: predictive value for postoperative cardiac events endothelial dysfunction 10-206