Congestive Heart Failure and Noncardiac Operations: Risk of Serious Morbidity, Readmission, Reoperation, and Mortality.
Congestive heart failure (CHF) predicts surgical morbidity and mortality. However, few studies evaluate CHF's impact on noncardiac operations. Because of CHFs serious threat to health and survival, surgeons must understand risks CHF poses to patients undergoing a diverse array of operations.



We used 2009 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Files to estimate the risk of serious morbidity, reoperation, readmission, mortality, and other postoperative complications associated with preoperative diagnosis of CHF. Multivariable logistic regression analysis provided odds ratios (OR) and 95% confidence intervals (CI) for outcomes in 34 ACS NSQIP procedure groups, controlling for age, sex, race, emergency surgery status, American Society of Anesthesiologists Classification, body mass index, and selected laboratory values.



Unadjusted ORs indicate adverse effects of CHF on surgical outcomes for most procedures considered. When adjusted for age and other confounders, CHF persists with adverse effects on most outcomes, including serious morbidity (OR 1.52, 95% CI, 1.44 to 1.61; p < 0.001); reoperation (OR 1.29, 95% CI, 1.17 to 1.42; p < 0.001); readmission (OR 1.39, 95% CI, 1.29 to 1.50; p < 0.001); and 30-day mortality (OR 1.96, 95% CI 1.80 to 2.13; p < 0.001). The impact of CHF on morbidity and mortality substantially affected those undergoing carotid endarterectomy and lower extremity endovascular repair. Cardiac arrest, mortality, unplanned intubation, and ventilator > 48 hours were complications most affected by CHF.



Congestive heart failure strongly predicts serious morbidity, unplanned reoperation, readmission, and surgical mortality for noncardiac operations. Surgeons must pay particular attention to recognizing CHF and optimizing perioperative management when considering surgery.
Department of Surgery, University of Virginia, Charlottesville, VA.
Florence E
FE
Turrentine
Department of Public Health Sciences, University of Virginia, Charlottesville, VA.
Min-Woong
MW
Sohn
Department of Surgery, University of Virginia, Charlottesville, VA. Electronic address: rsj@virginia.edu.
Rayford Scott
RS
Jones
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*