Worsening Preoperative Heart Failure Is Associated with Mortality and Noncardiac Complications, But Not Myocardial Infarction After Noncardiac Surgery

BACKGROUND: Heart failure (HF) is an important risk factor for perioperative morbidity and mortality. While these patients are at high risk for cardiac adverse events, there are few current data describing the types of noncardiac complications that occur in this population. METHODS: We performed a multicenter cohort study of patients undergoing noncardiac surgery from 2005 to 2010 as part of the American College of Surgeons National Surgical Quality Improvement Program. A HF cohort (HF that is new or worsening within 30 days of surgery) was compared with a control cohort that was matched regarding other surgical risk factors. RESULTS: Five thousand ninety-four patients with worsening preoperative HF were compared with an otherwise similar cohort of patients without worsening preoperative HF. Worsening preoperative HF was associated with increased risk of 30-day all-cause mortality (relative risk [RR] 2.08; 95% confidence interval [CI], 1.75-2.46; P < 0.001) and increased risk of morbidity (any recorded postoperative complication) (RR 1.54; 95% CI, 1.40-1.69; P < 0.001). HF patients had increased risk of developing renal failure (RR 1.85; 95% CI, 1.37-2.49; P < 0.001), need for mechanical ventilation longer than 48 hours (RR 1.81; 95% CI, 1.52-2.15; P < 0.001), pneumonia (RR 1.73; 95% CI, 1.44-2.08; P < 0.001), cardiac arrest (RR 1.69; 95% CI, 1.29-2.21; P < 0.001), unplanned intubation (RR 1.68; 95% CI, 1.41-1.99; P < 0.001), renal insufficiency (RR 1.64; 95% CI, 1.10-2.44; P = 0.014), sepsis (RR 1.43, 95% CI, 1.24-1.64; P < 0.001), and urinary tract infection (RR 1.29; 95% CI, 1.06-1.58; P = 0.011). The incidence of myocardial infarction in the sample was similar between the 2 groups (RR 1.07; 95% CI, 0.75-1.52; P = 0.719). CONCLUSIONS: Worsening preoperative HF is associated with a significant increase in postoperative morbidity and mortality when controlling for other comorbidities. Although these likely have a multifactorial etiology, patients are much more likely to suffer from respiratory, renal, and infectious complications than cardiac complications.