Impact of ejection fraction on infectious, renal, and respiratory morbidity for patients undergoing noncardiac surgery.
OBJECTIVE
We sought to determine if decreased left ventricular systolic function was associated with an increased risk of postoperative infectious, respiratory, or renal complications in patients undergoing noncardiac surgery.


METHODS
Retrospective cohort study.


METHODS
Single tertiary-care, university-based medical center.


METHODS
We studied individuals who participated in the American College of Surgeons National Quality Improvement Program and had a preoperative echocardiogram conducted at our institution.


METHODS
None.


METHODS
The incidences of postoperative respiratory (need for postoperative mechanical ventilation or unplanned intubation), renal (acute renal failure or renal insufficiency), and infectious (pneumonia, urinary tract infection, sepsis, or wound infection) complications were analyzed.


RESULTS
Postoperative infections (n=175, 10%) represented the most common postoperative complication seen in the study population of 1692 individuals. Respiratory complications occurred in 77 (5%) and renal complications occurred in 29 (2%) participants. The time between the echocardiogram and surgery ranged from 7 months (interquartile range [IQR] 1.8-15.7) for those with severely reduced left ventricular ejection fraction (LVEF) to 24 months (IQR 2.5-38.6) for those with a normal LVEF (P=.038). Univariate analysis demonstrated a relationship between decreased preoperative LVEF and infectious and renal complications, but not respiratory complications. After adjusting for preoperative characteristics, decreased preoperative LVEF was associated with infectious (odds ratio, 1.33; 95% confidence interval, 1.03-1.68; P=.0265) and renal (odds ratio, 1.69; 95% confidence interval, 1.12-2.48; P=.0142) complications.


CONCLUSIONS
Decreased preoperative LVEF is associated with postoperative infections and renal complications.
Department of Anesthesiology, University of Michigan, 1500 Medical Center Dr, Ann Arbor, MI, USA. Electronic address: mmaile@med.umich.edu.
Michael D
MD
Maile
Department Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 Medical Center Dr, Ann Arbor, MI, USA.
William F
WF
Armstrong
Department of Anesthesiology, University of Michigan, 1500 Medical Center Dr, Ann Arbor, MI, USA.
Elizabeth S
ES
Jewell
Department of Anesthesiology, University of Michigan, 1500 Medical Center Dr, Ann Arbor, MI, USA.
Milo C
MC
Engoren
D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012120:Respiration Disorders / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
Acute kidney injury; Echocardiography; Infection; Postoperative complications; Respiratory insufficiency; Ventricular ejection fraction