Heart Failure and Mortality Rates Following Noncardiac Surgeries


A study of more than 355,000 veterans found that heart failure, with and without symptoms, was associated with increased postoperative mortality rates.

A recent study is shining light onto the association of heart failure (HF) with mortality rates following noncardiac surgeries.

Investigators examined a cohort of more than 350,000 patients and found that patients with HF, with or without symptoms, had increased rates of 30- and 90-day mortality following noncardiac surgery — which they hope can help in preoperative discussions with patients undergoing ambulatory surgery. 

To assess mortality risk, conducted a retrospective cohort study on a population of 355,121 from the Veterans Affairs Surgical Quality Improvement Project Database (VASQIP). In their analyses, investigators excluded cardiac operations, emergency operations, and nonsurgical procedures. All VASQIP-sampled outpatient operations during the fiscal years 2009 to 2016 were eligible for inclusion.

The 30-day complication rate and 90-day all-cause mortality rates served as the primary outcomes of the study. The secondary outcomes were 30-day postoperative cardiac arrest, myocardial infarction, stroke, surgical site infection, urinary tract infection, and 72-hour postoperative bleeding event — which was defined as transfusion for any reason of more than 4 unites of packed red blood cells or whole blood after the patient has left the operating room. Social Security Administration Death Master Files were used to determine date of death.

Analyses performed by investigators accounted for multiple demographic and clinical characteristics of patients, including sex, age, race/ethnicity, body mass index, smoking, alcohol use, hypertension, atrial fibrillation, diabetes, coronary artery disease, history of stroke, asthma, chronic obstructive pulmonary disease, peripheral vascular disease, disseminated cancer, and surgical complexity level.

Investigators found that 5.5% (19,353) of the 355,121 included in the study had HF. The mean age of those patients was 67.9 (SD, 10.1) years and 96.96% (18,841) were male. Among the 334,768 without HF the mean age was 57.2 (14) years and 90% (301,198) were male. 

Upon analyses, investigators found that patients with HF had higher rates of 90-day postoperative mortality than patients without HF (crude mortality risk, 2.00% vs 0.39%; aOR, 1.95; 95% CI, 1.69-2.44). Investigators noted that in the same group, the risk of mortality progressively increased with decreasing systolic function. 

Both symptomatic patients (crude mortality risk, 3.57%; aOR, 2.76; 95% CI, 2.07-3.70) and asymptomatic patients (crude mortality risk, 1.85%; aOR, 1.85; 95% CI, 1.60-2.15) with HF were found to have a greater risk of mortality. Additionally, patients with HF had a higher risk of experiencing a 30-day postoperative e complication than patients without HF (crude risk, 5.65% vs 2.65%; aOR, 1.10; 95% CI, 1.02-1.19).

Investigators noted several limitations within their study. Due to the nature of the inclusion criteria, data was not available on patients who were considered but ultimately did not undergo surgery and on patients considered for ambulatory surgery but received inpatient surgery.

The analysis was also unable to compare baseline mortality rates not attributable because all patients in the study underwent surgery. As an observational study, some confounding factors that were not accounted could have impacted results. Lastly, because all participants were veterans, and most were men, the generalizability of the study was limited. 

This study, titled “Association Between Heart Failure and Postoperative Mortality Among Patients Undergoing Ambulatory Noncardiac Surgery,” was published in JAMA Surgery. 

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