June 28, 2011
View Full PaperMortality and Readmission of Patients With Heart Failure, Atrial Fibrillation, or Coronary Artery Disease Undergoing Noncardiac Surgery
Key Result
Nonischemic HF, ischemic HF, and AF were associated with higher 30-day mortality after noncardiac surgery compared to CAD (9.3%, 9.2%, and 6.4% vs 2.9%, respectively; P<0.0001).
Study Design
Type
Cohort (n=38,047)
Structured PICO
Does the presence of heart failure or atrial fibrillation increase 30-day postoperative mortality compared to coronary artery disease in patients undergoing noncardiac surgery?
P
Population
38,047 consecutive patients with nonischemic HF, ischemic HF, CAD, or AF undergoing noncardiac surgery, evaluated for 30-day postoperative mortality.
E
Exposure
Noncardiac surgery (major and minor) in patients with nonischemic HF, ischemic HF, or AF
C
Comparator
Noncardiac surgery in patients with CAD
O
Outcome
30-day postoperative mortalityhard clinical
Patients with heart failure or atrial fibrillation face a significantly higher risk of 30-day postoperative mortality after noncardiac surgery than those with coronary artery disease, suggesting current perioperative risk models may underestimate their risk.
Main Result
Odds Ratio: 2.92 (95% CI 2.44–3.48)
Absolute Event Rate: 9.3% vs 2.9%
p-value: p=<0.0001
Abstract
BACKGROUND: The postoperative risks for patients with coronary artery disease (CAD) undergoing noncardiac surgery are well described. However, the risks of noncardiac surgery in patients with heart failure (HF) and atrial fibrillation (AF) are less well known. The purpose of this study is to compare the postoperative mortality of patients with HF, AF, or CAD undergoing major and minor noncardiac surgery. METHODS AND RESULTS: Population-based data were used to create 4 cohorts of consecutive patients with either nonischemic HF (NIHF; n=7700), ischemic HF (IHF; n=12 249), CAD (n=13 786), or AF (n=4312) who underwent noncardiac surgery between April 1, 1999, and September 31, 2006, in Alberta, Canada. The main outcome was 30-day postoperative mortality. The unadjusted 30-day postoperative mortality was 9.3% in NIHF, 9.2% in IHF, 2.9% in CAD, and 6.4% in AF (each versus CAD, P<0.0001). Among patients undergoing minor surgical procedures, the 30-day postoperative mortality was 8.5% in NIHF, 8.1% in IHF, 2.3% in CAD, and 5.7% in AF (P<0.0001). After multivariable adjustment, postoperative mortality remained higher in NIHF, IHF, and AF patients than in those with CAD (NIHF versus CAD: odds ratio 2.92; 95% confidence interval 2.44 to 3.48; IHF versus CAD: odds ratio 1.98; 95% confidence interval 1.70 to 2.31; AF versus CAD: odds ratio 1.69; 95% confidence interval 1.34 to 2.14). CONCLUSIONS: Although current perioperative risk prediction models place greater emphasis on CAD than HF or AF, patients with HF or AF have a significantly higher risk of postoperative mortality than patients with CAD, and even minor procedures carry a risk higher than previously appreciated.