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Elective surgery increases risk for worse outcomes in HF
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Patients with HF who underwent elective ambulatory surgery had an increased risk for 30-day postoperative complications and 90-day mortality regardless of the presence of HF symptoms, according to a study published in JAMA Surgery.
“These data may be helpful in preoperative discussions with patients with heart failure undergoing ambulatory surgery,” Benjamin J. Lerman, MD, MS, MD/MS candidate in the division of epidemiology at Stanford University School of Medicine at the time of the study and now a resident physician at Children’s Hospital of Philadelphia, and colleagues wrote.
Two Veterans Affairs databases were used to assemble a cohort of 355,121 participants who underwent elective ambulatory surgery. Information assessed in this study included postoperative data and medical comorbidities. Echocardiogram reports were also reviewed for left ventricular ejection fraction. Participants were categorized as having HF (n = 19,353; mean age, 68 years; 97% men) or not having HF (n = 334,768; mean age, 57 years; 90% men).
The primary outcome of interest was the complication rate at 30 days and all-cause postoperative mortality at 90 days. Each participant had at least 1 year of follow-up data.
Participants with HF had an increased risk for postoperative mortality at 90 days compared with those without HF (crude mortality risk = 2% vs. 0.39%; adjusted OR = 1.95; 95% CI, 1.69-2.44). Mortality risk progressively increased as systolic function decreased.
Compared with participants without HF, a greater risk for mortality was seen in participants with symptomatic HF (crude mortality risk = 3.57%; aOR = 2.76; 95% CI, 2.07-3.7) and those with asymptomatic HF (crude mortality risk = 1.85%; aOR = 1.85; 95% CI, 1.6-2.15).
A higher risk for postoperative complications at 30 days was seen in participants with HF vs. those without HF (crude risk = 5.65% vs. 2.65%; aOR = 1.1; 95% CI, 1.02-1.19).
“Although some institution-specific regulations exist, the development of a consensus guideline has the potential to improve patient safety and patient outcomes, perhaps in particular among patients with heart failure,” Lerman and colleagues wrote. “Additional research on the risks associated with ambulatory surgery is warranted to further improve patient safety.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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