Adults with complex congenital heart disease undergoing non-cardiac surgery had a significantly higher risk of MACE compared to non-ACHD patients (OR 1.58; 95% CI 1.23-2.02).
Cohort (n=15,349)
Yes
Does non-cardiac surgery increase the risk of adverse outcomes and mortality in adults with congenital heart disease compared to non-ACHD patients?
Adults with moderate or complex congenital heart disease face a significantly higher risk of major adverse cardiovascular events and in-hospital mortality when undergoing non-cardiac surgery compared to patients without congenital heart disease.
Effect estimate: OR 1.58 (95% CI 1.23-2.02)
BACKGROUND: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality. METHODS: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD. RESULTS: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD. CONCLUSIONS: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.
Friedrich et al. (Sat,) conducted a cohort in Adults with congenital heart disease undergoing non-cardiac surgeries (n=15,349). Moderate and complex congenital heart disease vs. Propensity score matched cohort of non-ACHD was evaluated on Major adverse cardiovascular events (MACE), major infection, major bleeding, major thromboembolism, and in-hospital death (OR 1.58, 95% CI 1.23-2.02). Adults with complex congenital heart disease undergoing non-cardiac surgery had a significantly higher risk of MACE compared to non-ACHD patients (OR 1.58; 95% CI 1.23-2.02).