Non-cardiac surgeries in adults with congenital heart disease -influence of complexity of disease and estimated risk of surgery on adverse events

Abstract

Background: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality.

Methods: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD.

Results: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD.

Conclusions: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.

Keywords: Adult congenital heart disease; Congenital heart defect; Non-cardiac surgery; Peri-operative risk; Surgery specialty; Surgical procedures.