Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies.

Summary

Across VISION (n=35,815) and POISE-2 (n=9,219), lower preoperative eGFR showed a strong, graded association with 30-day cardiac events, with attenuation at older ages. Adding continuous eGFR (and its age interaction) improved predictive information, discrimination, and net benefit in multivariable models.

Key Findings

• Lower preoperative eGFR had a strong, graded association with 30-day cardiac events in both VISION and POISE-2.
• The association was attenuated by older age, indicating an age interaction.
• Adding continuous eGFR improved predictive information, discrimination (C-statistic), and net benefit in multivariable models.

Clinical Implications

Incorporate continuous eGFR (with age interaction) into preoperative risk assessments to improve identification of patients at cardiac risk and guide optimization and monitoring strategies.

Limitations

• Secondary analysis; residual confounding cannot be excluded.
• Generalizability to urgent or outpatient procedures requires confirmation.

Future Directions

External validation and integration of continuous eGFR with age interaction into perioperative risk calculators; evaluate effects on clinical decision-making and outcomes.