What is the Relationship Between Chronic Heart Failure and Operation size? A systematic Review

Background: Heart failure is a chronic progressive failure of the heart muscle to pump blood to meet the body’s oxygen demands. Heart failure impacts on perioperative outcomes of non-cardiac surgery, with higher risks of post-operative complications and mortality. The aim of this study was to review current clinical evidence to assess if there was a relationship between heart failure, operation size and post operative outcomes Methods: PRISMA guidelines were implemented to complete a systematic review. The review was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42022313897). PubMed was searched from 1940 to 2022 using the terms “heart failure”, “noncardiac surgery”, “thyroid surgery”, “breast surgery”, “asymptomatic carotid endarterectomy”, “hernia”, “cholecystectomy”. “laparoscopy”, laparotomy”, “peripheral angioplasty”, “EVAR”, “neck of femur”, “abdominal aortic aneurysm”, and “lower extremity revascularisation”. Inclusion criteria included: experimental and observational studies; pre operative diagnosis of heart failure; 30d morbidity and mortality; non cardiac surgery. Results: 47 articles relevant to the inclusion criteria were analysed. Five studies assessed low risk operations; 29 assessed intermediate risk operations; 8 assessed high risk operations; 5 assessed intermediate and high-risk operations. For low, intermediate and high-risk operations, heart failure was associated with a statistically significant increased risk of mortality and morbidity (p lessthan0.05). Conclusions: Heart failure is associated with increased morbidity and mortality independent of operation size or risk. Challenges remain in assessing the relationship between heart failure and operation outcome due to variations in disease spectrum and the impact of additional co-morbidities.