Outcomes of patients with stable heart failure undergoing elective noncardiac surgery.
OBJECTIVE
To evaluate modern surgical outcomes in patients with stable heart failure undergoing elective major noncardiac surgery and to compare the experience of patients with heart failure who have reduced vs preserved left ventricular ejection fraction (EF).


METHODS
We retrospectively studied 557 consecutive patients with heart failure (192 EF less than or equal to 40% and 365 EF greater than 40%) and 10,583 controls who underwent systematic evaluation by hospitalists in a preoperative clinic before having major elective noncardiac surgery between January 1, 2003, and March 31, 2006. We examined outcomes in the entire cohort and in propensity-matched case-control groups.


RESULTS
Unadjusted 1-month postoperative mortality in patients with both types of heart failure vs controls was 1.3% vs 0.4% (P equals .009), but this difference was not significant in propensity-matched groups (P equals .09). Unadjusted differences in mean hospital length of stay among heart failure patients vs controls (5.7 vs 4.3 days; P less than .001) and 1-month readmission (17.8% vs 8.5%; P less than .001) were also markedly attenuated in propensity-matched groups. Crude 1-year hazard ratios for mortality were 1.71 (95% confidence interval [CI], 1.5-2.0) for both types of heart failure, 2.1 (95% CI, 1.7-2.6) in patients with heart failure who had EF less than or equal to 40%, and 1.4 (95% CI, 1.2-1.8) in those who had EF greater than 40% (P less than .01 for all 3 comparisons); however, the differences were not significant in propensity-matched groups (P equals .43).


CONCLUSIONS
Patients with clinically stable heart failure did not have high perioperative mortality rates in association with elective major noncardiac surgery, but they were more likely than patients without heart failure to have longer hospital stays, were more likely to require hospital readmission, and had a substantial long-term mortality rate.
Xu-Cai
Ye Olivia
YO
Department of Hospital Medicine, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. caio@ccf.org
Brotman
Daniel J
DJ
Phillips
Christopher O
CO
Michota
Franklin A
FA
Tang
W H Wilson
WH
Whinney
Christopher M
CM
Panneerselvam
Ashok
A
Hixson
Eric D
ED
Garcia
Mario
M
Francis
Gary S
GS
Jaffer
Amir K
AK
D000368:Aged; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D004452:Echocardiography; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors