Document Detail

Impact of heart failure on patients undergoing major noncardiac surgery.
MedLine Citation:
PMID:  18362586     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Changes in the demographics and epidemiology of patients with cardiovascular comorbidities who undergo major noncardiac surgery require an updated assessment of which patients are at greater risk of mortality or readmission. The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD), or neither who underwent major noncardiac surgery. METHODS: Patients were aged 65 and older, had Medicare fee-for-service coverage, and underwent 1 of 13 major noncardiac procedures from 2000 through 2004, excluding patients with end-stage renal disease and patients who did not have at least 1 yr of Medicare fee-for-service eligibility before surgery. Main outcome measures were operative mortality and 30-day all-cause readmission. RESULTS: Of 159,327 procedures, 18% were performed in patients with heart failure and 34% were performed in patients with CAD. Adjusted hazard ratios of mortality and readmission for patients with heart failure, compared with patients with neither heart failure nor CAD, were 1.63 (95% confidence interval, 1.52-1.74) and 1.51 (95% confidence interval, 1.45-1.58), respectively. Adjusted hazard ratios of mortality and readmission for patients with CAD, compared with patients with neither heart failure nor CAD, were 1.08 (95% confidence interval, 1.01-1.16) and 1.16 (95% confidence interval, 1.12-1.20), respectively. These effects were statistically significant. Patients with heart failure were at significantly higher risk for both outcomes compared with patients with CAD. CONCLUSIONS: Elderly patients with heart failure 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. Improvements in perioperative care are needed for the growing population of patients with heart failure undergoing major noncardiac surgery.
Bradley G Hammill; Lesley H Curtis; Elliott Bennett-Guerrero; Christopher M O'Connor; James G Jollis; Kevin A Schulman; Adrian F Hernandez
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  108     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-25     Completed Date:  2008-04-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  559-67     Citation Subset:  AIM; IM    
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North Carolina, USA.
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MeSH Terms
Aged, 80 and over
Heart Failure / complications,  mortality*,  surgery*
Patient Readmission / trends
Perioperative Care / adverse effects,  mortality,  trends
Risk Factors
Surgical Procedures, Operative / adverse effects*,  mortality*,  trends
Comment In:
Anesthesiology. 2008 Apr;108(4):551-2   [PMID:  18362582 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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