Anesthesiology: Major non-cardiac surgery increases risk of elderly heart failure

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Elderly patients with heart failure (HF) who undergo major surgical procedures have substantially higher risks of operative mortality and hospital readmission than other patients, including those with coronary disease, admitted for the same procedures, according to a study in the April issue of Anesthesiology.

Through the study, Bradley G. Hammill, from the Duke Clinical Research Institute in Durham, N.C., and colleagues evaluated short-term outcomes among patients with HF, coronary artery disease (CAD) or neither who underwent major non-cardiac surgery.

Patients, aged 65 and older, had Medicare fee-for-service coverage, and underwent one of 13 major non-cardiac procedures from Jan. 1, 2000 through Dec. 31, 2004. The study excluded patients with end-stage renal disease and patients who did not have at least one year of Medicare fee-for-service eligibility before surgery, according to researchers.

The investigators said that the main outcome measures were operative mortality and 30-day all-cause readmission.

Of 159,327 procedures, the authors wrote that 18 percent were performed in patients with HF and 34 percent were performed in patients with CAD.

The researchers reported that the adjusted hazard ratios of mortality and readmission for patients with HF, compared with patients with neither HF nor CAD, were 1.63 and 1.51, respectively. Adjusted hazard ratios of mortality and readmission for patients with CAD compared with patients with neither HF nor CAD, were 1.08 and 1.16, respectively.

The authors wrote that the effects were statistically significant, and patients with HF were at significantly higher risk for both outcomes compared with patients with CAD.

“Despite improvements in peri-operative care and care for chronic heart failure, improvements are needed for the growing population of patients with heart failure undergoing major non-cardiac surgery,” the authors wrote.

The limitations of the study included the use of administrative data, which limited the clinical information available and may have led to misclassification and absence of information on the nature of the heart failure, the researchers noted.

The researchers concluded that improvements in peri-operative care are needed for the growing population of patients with heart failure undergoing major non-cardiac surgery.