Association between heart failure and perioperative outcomes in patients undergoing non-cardiac surgery

Abstract

Aims: Heart failure (HF) affects ∼5.7 million US adults and many of these patients develop non-cardiac disease that requires surgery. The aim of this study was to determine perioperative outcomes associated with HF in a large cohort of patients undergoing in-hospital non-cardiac surgery.

Methods and results: Adults ≥18 years old undergoing non-cardiac surgery between 2012 and 2014 were identified using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients with HF were identified by ICD-9 diagnosis codes. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression models were used to estimate associations between HF and outcomes. A total of 21 560 996 surgical hospitalizations were identified, of which 1 063 405 (4.9%) had a diagnosis of HF. Among hospitalizations with HF, 4.7% had acute HF, 11.3% had acute on chronic HF, 27.8% had chronic HF, and 56.2% had an indeterminate diagnosis code that did not specify temporality. In-hospital perioperative mortality was more common among patients with any diagnosis of HF compared to those without HF [4.8% vs. 0.78%, P < 0.001; adjusted odds ratio (aOR) 2.15, 95% confidence interval (CI) 2.09-2.22], and the association between HF and mortality was greatest at small and non-teaching hospitals. Acute HF without chronic HF was associated with 8.0% mortality. Among patients with a chronic HF diagnosis, perioperative mortality was greater in those with acute on chronic HF compared to chronic HF alone (7.8% vs. 3.9%, P < 0.001; aOR 1.78, 95% CI 1.67-1.90).

Conclusion: In patients hospitalized for non-cardiac surgery, HF was common and was associated with increased risk of perioperative mortality. The greatest risks were in patients with acute HF.

Keywords: Heart failure; Mortality; Outcomes; Perioperative; Surgery.

Figure 1

In-hospital mortality by non-cardiac surgical subtype in patients with and without a diagnosis of heart failure.

Figure 2

Adjusted odds of mortality associated with a diagnosis of heart failure, stratified by hospital size (A) and hospital teaching status (B).

Figure 3

Adjusted odds of mortality associated with heart failure, stratified by heart failure presentation.^{b a}Indeterminate heart failure excludes individuals with any ICD-9 code for heart failure that specifies the temporality of the diagnosis. ^bAdjusted odds of mortality for all groups are compared to individuals without a heart failure diagnosis during the surgical hospitalization.