Patients Undergoing Major Cancer Surgery: Incidence and Predictive Value for Postoperative Cardiac Events

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.