title: Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients.
abstract: BACKGROUND
  The postoperative risks for patients with coronary artery disease (CAD) undergoing noncardiac surgery are well described. However, the risks of noncardiac surgery in patients with heart failure (HF) and atrial fibrillation (AF) are less well known. The purpose of this study is to compare the postoperative mortality of patients with HF, AF, or CAD undergoing major and minor noncardiac surgery.
  
  
  RESULTS
  Population-based data were used to create 4 cohorts of consecutive patients with either nonischemic HF (NIHF; n=7700), ischemic HF (IHF; n=12 249), CAD (n=13 786), or AF (n=4312) who underwent noncardiac surgery between April 1, 1999, and September 31, 2006, in Alberta, Canada. The main outcome was 30-day postoperative mortality. The unadjusted 30-day postoperative mortality was 9.3% in NIHF, 9.2% in IHF, 2.9% in CAD, and 6.4% in AF (each versus CAD, P<0.0001). Among patients undergoing minor surgical procedures, the 30-day postoperative mortality was 8.5% in NIHF, 8.1% in IHF, 2.3% in CAD, and 5.7% in AF (P<0.0001). After multivariable adjustment, postoperative mortality remained higher in NIHF, IHF, and AF patients than in those with CAD (NIHF versus CAD: odds ratio 2.92; 95% confidence interval 2.44 to 3.48; IHF versus CAD: odds ratio 1.98; 95% confidence interval 1.70 to 2.31; AF versus CAD: odds ratio 1.69; 95% confidence interval 1.34 to 2.14).
  
  
  CONCLUSIONS
  Although current perioperative risk prediction models place greater emphasis on CAD than HF or AF, patients with HF or AF have a significantly higher risk of postoperative mortality than patients with CAD, and even minor procedures carry a risk higher than previously appreciated.
authors.affiliation: Mazankowski Alberta Heart Institute, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: van Diepen
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D002170:Canada; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000009:adverse effects