Outcomes in heart failure patients after major noncardiac surgery.
OBJECTIVE
The purpose of this study was to evaluate mortality and readmission rates of heart failure (HF) patients after major noncardiac surgery.


BACKGROUND
There is a lack of generalizable outcome data on HF patients undergoing major noncardiac surgery because previous studies have been limited to a few academic centers or have not focused on this group of patients.


METHODS
Using the 1997 to 1998 Standard Analytic File 5% Sample of Medicare beneficiaries, we identified patients with HF who underwent major noncardiac surgery. A multivariable logistic regression model was used to provide adjusted mortality and readmission rates in patients after noncardiac surgery. Patients with coronary artery disease (CAD) and all other remaining patients (Control) who had similar surgery served as reference groups.


RESULTS
Of 23,340 HF patients and 28,710 CAD patients, 1,532 (6.56%) HF patients and 1,757 (6.12%) CAD patients underwent major noncardiac surgery. There were 44,512 patients in the Control group with major noncardiac surgery. After accounting for demographic characteristics, type of surgery, and comorbid conditions, the risk-adjusted operative mortality (death before discharge or within 30 days of surgery) was HF 11.7%, CAD 6.6%, and Control 6.2% (HF vs. CAD, p < 0.001; CAD vs. Control, p = 0.518). The risk-adjusted 30-day readmission rate was HF 20.0%, CAD 14.2%, and Control 11.0% (p < 0.001).


CONCLUSIONS
In patients 65 years of age and older, HF patients undergoing major noncardiac surgery suffer substantial morbidity and mortality despite advances in perioperative care, whereas patients with CAD without HF have similar mortality compared with a more general population.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. herna014@mc.duke.edu <herna014@mc.duke.edu>
Adrian F
AF
Hernandez
David J
DJ
Whellan
Sharon
S
Stroud
Jie Lena
JL
Sun
Christopher M
CM
O'Connor
James G
JG
Jollis
D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality