Key result
Preoperative hypothyroidism is linked to ~70% higher odds of in-hospital mortality after cardiac surgery.
Why the study?
The association between preoperative hypothyroidism and postoperative complications and mortality following cardiac surgery remained poorly understood.
Is preoperative hypothyroidism associated with increased postoperative complications and mortality in patients undergoing cardiac surgery?
Meta-Analysis (n=40,968)
Is preoperative hypothyroidism associated with increased postoperative complications and mortality in patients undergoing cardiac surgery?
Preoperative hypothyroidism is associated with increased risks of acute kidney injury, myocardial infarction, major adverse cardiovascular events, and mortality following cardiac surgery, supporting preoperative thyroid function assessment.
Answers are grounded in this paper and cite their sources.
May inform preoperative risk awareness in cardiac surgery; leaves open need for trials on thyroid optimization.
Introduction The association between hypothyroidism and prognosis following cardiac surgery remains poorly understood. This study evaluated the association of preoperative hypothyroidism with postoperative complications and mortality. Methods PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, and Scopus were searched from inception to December 17, 2025, to identify eligible studies. Pooled odds ratios and 95% confidence intervals were calculated to assess the associations between hypothyroidism and postoperative outcomes. Subgroup and leave-one-out sensitivity analyses explored heterogeneity and assessed the stability of the findings. Results A total of 40,968 patients were enrolled in 22 studies for pooled analysis. For postoperative complications, more patients in the hypothyroid group developed acute kidney injury (OR = 2.61, 95% CI = 1.85 to 3.69, P = 0.00, I 2 = 0.00%), myocardial infarction (OR = 1.66, 95% CI = 1.23 to 2.23, P = 0.00, I 2 = 11.94%) and major adverse cardiovascular events (OR = 1.59, 95% CI = 1.45 to 1.74, P = 0.00, I 2 = 0.00%). However, regarding atrial fibrillation (OR = 1.24, 95% CI = 0.89 to 1.71, P = 0.20, I 2 = 71.05%), heart failure (OR = 1.46, 95% CI = 0.92 to 2.33, P = 0.11, I 2 = 0.00%), and stroke (OR = 1.36, 95% CI = 0.93 to 2.00, P = 0.11, I 2 = 0.00%), no statistically significant differences were observed between the two groups. As for mortality, both in-hospital mortality (OR = 1.70, 95% CI = 1.03 to 2.79, P = 0.04, I 2 = 0.00%) and long-term mortality (OR = 1.70, 95% CI = 1.29 to 2.25, P = 0.00, I 2 = 62.52%) were higher in the hypothyroid group. In additional analyses restricted to adjusted effect estimates, the association with heart failure reached statistical significance (aOR = 1.53, 95% CI = 1.14 to 2.04, P = 0.00, I 2 = 0.00%), whereas the associations with myocardial infarction and long-term mortality were not statistically significant. Conclusion This study demonstrates that preoperative hypothyroidism was associated with several adverse outcomes following cardiac surgery, providing supportive evidence that surgeons should assess patients’ thyroid function and initiate appropriate interventions preoperatively.
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Dai et al. (2026) conducted a meta-analysis in Patients undergoing cardiac surgery (n=40,968). Preoperative hypothyroidism vs. No preoperative hypothyroidism (euthyroid) was evaluated on In-hospital mortality (OR 1.70, 95% CI 1.03 to 2.79, p=0.04). Preoperative hypothyroidism was associated with higher odds of in-hospital mortality (OR 1.70, 95% CI 1.03-2.79), MACE (OR 1.59), and AKI (OR 2.61) after cardiac surgery.
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