Is Preoperative Endothelial Dysfunction a Potentially Modifiable Risk Factor for XXXX Associated With Noncardiac Surgery?

@entity1 @entity8 @entity296 @entity409 @entity450 @entity810 @entity1011
OBJECTIVES: To determine whether preoperative @entity409 provides risk stratification for perioperative @entity8 in @entity1 undergoing noncardiac surgery. The relationship between perioperative @entity8 and @entity296 after noncardiac surgery (MINS) was explored secondarily. DESIGN: An observational study. SETTING: Two academic medical centers. @entity1 : A total of 218 @entity1 scheduled to undergo intermediate or high-risk noncardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: @entity409 was identified preoperatively by a Reactive @entity450 -Peripheral Arterial Tonometry (RH-PAT) index. @entity8 was defined by peak delta serum @entity1011 (  SCr) or @entity1011 -based @entity8 : Improving global outcomes @entity810 ( @entity810 ) criteria within 7 days postoperatively. MINS was defined by peak troponin>= 0.04   g/L within 3 days postoperatively. @entity810 occurred in 22 @entity1 (10.1%). Median RH-PAT index within the study cohort was 1.64 (range 1.03-4.96) and did not differ between @entity1 with or without @entity810 . When adjusted for covariates, there was no association between RH-PAT index and either @entity810 or peak   SCr. MINS occurred in 32 @entity1 (14.7%) and was associated independently with the outcome of @entity810 (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.2-10.8; p = 0.02) and peak   SCr (b-regression coefficient 23; 95% CI, 9-37; p = 0.002). Co-occurrence of @entity810 and MINS portended a marked increase in 30-day mortality (OR, 43; 95% CI, 6-305; p = 0.001) and delayed time to discharge (hazard ratio, 0.27; 95% CI, 0.13-0.54; p = 0.001). CONCLUSIONS: For @entity1 undergoing noncardiac surgery, preoperative endothelial function assessed by noninvasive peripheral arterial tonometry was not associated with perioperative @entity810 . @entity8 was associated strongly with MINS, and this may represent a mechanism by which @entity810 increases adverse outcomes.
