Elderly patients with heart failure undergoing major noncardiac surgery had significantly higher risks of operative mortality (HR 1.63; 95% CI 1.52-1.74) and 30-day readmission than those without.
Cohort (n=159,327)
Does the presence of heart failure increase the risk of operative mortality and 30-day readmission in elderly patients undergoing major noncardiac surgery compared to those with CAD or neither?
Elderly patients with heart failure undergoing major noncardiac surgery have substantially higher risks of operative mortality and 30-day readmission compared to those with CAD or neither condition.
Hazard Ratio: 1.63 (95% CI 1.52–1.74)
BACKGROUND: Changes in the demographics and epidemiology of patients with cardiovascular comorbidities who undergo major noncardiac surgery require an updated assessment of which patients are at greater risk of mortality or readmission. The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD), or neither who underwent major noncardiac surgery. METHODS: Patients were aged 65 and older, had Medicare fee-for-service coverage, and underwent 1 of 13 major noncardiac procedures from 2000 through 2004, excluding patients with end-stage renal disease and patients who did not have at least 1 yr of Medicare fee-for-service eligibility before surgery. Main outcome measures were operative mortality and 30-day all-cause readmission. RESULTS: Of 159,327 procedures, 18% were performed in patients with heart failure and 34% were performed in patients with CAD. Adjusted hazard ratios of mortality and readmission for patients with heart failure, compared with patients with neither heart failure nor CAD, were 1.63 (95% confidence interval, 1.52-1.74) and 1.51 (95% confidence interval, 1.45-1.58), respectively. Adjusted hazard ratios of mortality and readmission for patients with CAD, compared with patients with neither heart failure nor CAD, were 1.08 (95% confidence interval, 1.01-1.16) and 1.16 (95% confidence interval, 1.12-1.20), respectively. These effects were statistically significant. Patients with heart failure were at significantly higher risk for both outcomes compared with patients with CAD. CONCLUSIONS: Elderly patients with heart failure who undergo major surgical procedures have substantially higher risks of operative mortality and hospital readmission than other patients, including those with coronary disease, admitted for the same procedures. Improvements in perioperative care are needed for the growing population of patients with heart failure undergoing major noncardiac surgery.
Hammill et al. (Tue,) conducted a cohort in Major noncardiac surgery (n=159,327). Heart failure vs. Neither heart failure nor CAD was evaluated on Operative mortality (HR 1.63, 95% CI 1.52-1.74). Elderly patients with heart failure undergoing major noncardiac surgery had significantly higher risks of operative mortality (HR 1.63; 95% CI 1.52-1.74) and 30-day readmission than those without.