Accuracy of Preoperative Lung Ultrasound Score for the prediction of Major Adverse Cardiac Events in elderly patients undergoing HIP Surgery under Spinal Anesthesia: the LUSHIP multicenter observational prospective study.

Hip fracture Lung ultrasound Major adverse cardiac events Post-operative pneumonia Preoperative evaluation

Journal

Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401

Informations de publication

Date de publication:
04 Oct 2024
Historique:
received: 04 06 2024
revised: 26 08 2024
accepted: 29 08 2024
medline: 7 10 2024
pubmed: 7 10 2024
entrez: 6 10 2024
Statut: aheadofprint

Résumé

We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA). Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy. A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55-9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p <  0.001. The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score. Registered at clinicaltrials.gov as NCT04074876.

Sections du résumé

BACKGROUND AND OBJECTIVE OBJECTIVE
We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA).
METHODS METHODS
Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy.
RESULTS RESULTS
A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55-9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p <  0.001.
CONCLUSIONS CONCLUSIONS
The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score.
REGISTRATION BACKGROUND
Registered at clinicaltrials.gov as NCT04074876.

Identifiants

DOI: 10.1016/j.accpm.2024.101432 PMID: 39369987
pubmed: 39369987
pii: S2352-5568(24)00090-0
doi: 10.1016/j.accpm.2024.101432
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT04074876']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101432

Informations de copyright

Copyright © 2024. Published by Elsevier Masson SAS.

Auteurs

Luigi Vetrugno (L)

Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy. Electronic address: luigi.vetrugno@unich.it.

Enrico Boero (E)

Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy. Electronic address: https://twitter.com/ricoboero.

Paola Berchialla (P)

Center of Biostatistics, Epidemiology and Public Health, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.

Francesco Forfori (F)

Department Anesthesia and Intensive Care, University of Pisa, Pisa, Italy.

Mattia Bernardinetti (M)

Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy.

Savino Spadaro (S)

Department of Translational Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy. Electronic address: https://twitter.com/savino_spadaro.

Gianmaria Cammarota (G)

Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy. Electronic address: https://twitter.com/gmcamma.

Andrea Bruni (A)

Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Italy.

Eugenio Garofalo (E)

Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Italy.

Marco Tescione (M)

Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.

Cristian Deana (C)

Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy. Electronic address: https://twitter.com/DeanaCristian85.

Nicola Federici (N)

Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.

Lisa Mattuzzi (L)

Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy.

Francesco Meroi (F)

Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.

Luca Flaibani (L)

Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy.

Andrea Cortegiani (A)

Department of Surgical Oncological and Oral Science, University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy. Electronic address: https://twitter.com/AndCorteg.

Federico Longhini (F)

Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Italy. Electronic address: https://twitter.com/LonghiniFede.

Alessandro Cavarape (A)

Internal Medicine, Udine University Hospital, Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy.

Daniele Guerino Biasucci (DG)

Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy.

Stefano D'Incà (S)

Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy.

Anna Pesamosca (A)

Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy.

Agnese Cattarossi (A)

Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy.

Saskia Granzotti (S)

Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy.

Loris D'Orlando (L)

Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy.

Felice Urso (F)

Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy.

Camilla Colombotto (C)

Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy.

Pieter Roel Tuinman (PR)

Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

Edoardo De Robertis (E)

Anesthesia and Intensive Care, Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy.

Sergio Livigni (S)

Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy.

Salvatore Maurizio Maggiore (SM)

Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Critical Care Medicine and Emergency Department of Anesthesiology, SS. Annunziata Hospital, Chieti, Italy. Electronic address: https://twitter.com/rinomaggiore.

Vito Marco Ranieri (VM)

Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy; Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S. Orsola, Bologna, Italy.

Elena Giovanna Bignami (EG)

Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy. Electronic address: https://twitter.com/ElenaG_Bignami.

Classifications MeSH