Journal Article

Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies

Ackland, Gareth L., Minto, Gary, May, Shaun M., Cuthbertson, Brian H., Reynolds, Joseph A., Pearse, Rupert M., Abbott, Tom E. F., Prabhu, Pradeep, Wijesundera, Duminda, Owen, Thomas, Clark, Martin

2019

Overview

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. 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). 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<0.001)), neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14-1.68); p = 0.001) within 5 days of surgery. Multi-organ dysfunction is more common in surgical patients with cardiac vagal dysfunction, defined as HRR ≤ 12 bpm after preoperative cardiopulmonary exercise testing. ISRCTN88456378.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Analysis / Anesthesia / Anesthesiology / Biology and Life Sciences / Bone surgery / Brain stem / Cardiovascular disease / Confidence intervals / Critical care / Exercise / Exercise Test / Female / Health aspects / Health risk assessment / Health sciences / Heart diseases / Heart failure / Heart Injuries - physiopathology / Heart Rate / Hospitals / Humans / Inflammation / Male / Medical research / Medicine / Medicine and Health Sciences / Methods / Middle Aged / Morbidity / Observational studies / Pain / Parasympathetic nervous system / Patients / Physical training / Postoperative Complications - physiopathology / Prospective Studies / Recovery (Medical) / Regression analysis / Secondary analysis / Statistical analysis / Studies / Surgery / Vagus nerve / Vagus Nerve - physiopathology