Association between heart failure and perioperative outcomes in patients undergoing non-cardiac surgery

Abstract

Aims Heart failure (HF) affects ∼5.7 million US adults and many of these patients develop non-cardiac disease that requires surgery. The aim of this study was to determine perioperative outcomes associated with HF in a large cohort of patients undergoing in-hospital non-cardiac surgery. Methods and results Adults ≥18 years old undergoing non-cardiac surgery between 2012 and 2014 were identified using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients with HF were identified by ICD-9 diagnosis codes. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression models were used to estimate associations between HF and outcomes. A total of 21 560 996 surgical hospitalizations were identified, of which 1 063 405 (4.9%) had a diagnosis of HF. Among hospitalizations with HF, 4.7% had acute HF, 11.3% had acute on chronic HF, 27.8% had chronic HF, and 56.2% had an indeterminate diagnosis code that did not specify temporality. In-hospital perioperative mortality was more common among patients with any diagnosis of HF compared to those without HF [4.8% vs. 0.78%, P < 0.001; adjusted odds ratio (aOR) 2.15, 95% confidence interval (CI) 2.09–2.22], and the association between HF and mortality was greatest at small and non-teaching hospitals. Acute HF without chronic HF was associated with 8.0% mortality. Among patients with a chronic HF diagnosis, perioperative mortality was greater in those with acute on chronic HF compared to chronic HF alone (7.8% vs. 3.9%, P < 0.001; aOR 1.78, 95% CI 1.67–1.90). Conclusion In patients hospitalized for non-cardiac surgery, HF was common and was associated with increased risk of perioperative mortality. The greatest risks were in patients with acute HF.

The Association Between Congestive Heart Failure and One-Year Mortality After Surgery in Singaporean Adults: A Secondary Retrospective Cohort Study Using Propensity-Score Matching, Propensity Adjustment, and Propensity-Based Weighting

“…A study conducted in Sweden showed that the crude and adjusted HRs for 30day mortality after elective surgery in patients with CHF were 5.36 and 1.79, respectively (9). An analysis of 21,560,996 surgical hospitalisations revealed that the adjusted OR for in-hospital perioperative mortality in patients was 2.15 (11). Another study found similar results; compared with patients without CHF, patients with CHF had a 96% increased risk of 30-day mortality (10).…”

“…Although CHF has been recognised as a risk factor for postoperative mortality and has been incorporated into several risk indicators (4)(5)(6)(7)(8), few studies have examined the relationship between CHF and postoperative mortality. The hazard ratio (HR)/odds ratio (OR) produced by previous studies on the relationship between CHF and the prognosis of surgical patients varied widely (9)(10)(11).…”

Etiology and Comorbidity Diagnoses Effect on Outcomes for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

“…This study evaluated the intersection of etiology, comorbidities, and undergoing ERCP. It is well-documented that conditions like CHF, CLD, anemia, coagulopathies, and DM can negatively affect surgical outcomes in general [6][7][8][9][10][11], and in the case of CLD, previous negative outcomes have been directly linked to ERCP [5]. While most studies only look at mortality in reference to outcomes, this study also evaluated non-medical outcomes, such as total charges and patient length of stay (LOS).…”

Heart Failure Relapses in Response to Acute Stresses – Role of Immunological and Inflammatory Pathways

“…The prevalence of HF in the VA Surgical Quality Affairs population was 7.9% in patients undergoing non-cardiac surgery and preexisting HF resulted in increased mortality with an odd's ratio of 1.69 (CI 1.57–1.76) ( 39 ). Patients with preexisting HF undergoing non-cardiac surgery in other very large retrospective cohort studies (AHRQ-NIS) with less selected patient populations likewise carried dramatically increased mortality and rehospitalization risks ( 40 ). Preexisting HF causes rehospitalization due to CV and non-CV causes in more than 10% of the patients compared to 2.5% ( 41 ).…”

“…In addition, surgery induces an adrenergic stress response originating from pain and tissue destruction and translating into hemodynamic changes such as increased blood pressure and heart rate. Augmented adrenergic responses will trigger more inflammation and increased blood pressure and heart rate increase the risk for deterioration of LV function ( 40 , 42 , 45 ).…”