Perioperative outcomes of heart failure (HF) patients who have been clinically stabilized prior to noncardiac surgery have not been well studied. We sought to evaluate contemporary surgical outcomes in patients with compensated HF undergoing elective major noncardiac surgery, and to compare the experience of HF patients with reduced versus preserved left ventricular ejection fraction (EF).
We evaluated consecutive HF patients (mean age 69 ± 12 years) who underwent systematic optimization by hospitalists in a preoperative clinic between 2003 and 2006. These patients were dichotomized by ejection fraction: ≤40% versus > 40%. Patients without HF served as controls. We used propensity matching to compare outcomes between HF patients and controls.
A total of 562 HF patients (192 EF ≤ 40% and 370 EF > 40%) and 10,693 controls were followed for a median of 1.9 years postoperatively. Unadjusted 1‐month postoperative mortality with HF versus controls was 1.3% versus 0.4% (P = .009), but this difference was no longer significant in propensity‐matched groups (P = .76). Unadjusted differences in mean hospital length of stay of HF patients versus controls (5.7 vs. 4.3 days P < .001) and 1‐month readmission (17.6% vs. 8.5%, P < .001) were also markedly attenuated in propensity matching. Crude 1‐year mortality of HF patients with reduced EF ≤ 40%, those with preserved EF > 40%, and controls was 13.5%, 6.5%, and 3.2%, respectively (P < .001 for all 3 comparisons); however only for HF patients with reduced EF ≤ 40% versus controls did a significant difference in 1‐year mortality persist after propensity matching (P = .017).
Compensated HF was not associated with significant short‐term perioperative risk in association with elective major noncardiac surgery. HF with reduced EF had a substantial 1‐year mortality risk, but this may not have been attributable to surgery because short‐term mortality was low.
O. Cai, None; D. J. Brotman, None; C. O. Phillips, None; F. A. Michota, None; C. M. Whinney, None; W. W. Tang, None; M. Garcia, None; J. Feng, None; G. Francis, None; A. K. Jaffer, None.
To cite this abstract:Cai O, Brotman D, Phillips C, Michota F, Whinney C, Tang W, Garcia M, Feng J, Francis G, Jaffer A. Outcomes of Compensated Heart Failure Patients Undergoing Elective Major Noncardiac Surgery. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 13. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/outcomes-of-compensated-heart-failure-patients-undergoing-elective-major-noncardiac-surgery/. Accessed March 28, 2020.