Congestive Heart Failure and Noncardiac Operations: Risk of Serious Morbidity, Readmission, Reoperation, and Mortality
| Autor: | Florence E. Turrentine, Rayford Scott Jones, Min-Woong Sohn |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Multivariate analysis Databases Factual 030204 cardiovascular system & hematology Logistic regression Patient Readmission Operational risk 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Outcome Assessment Health Care Odds Ratio medicine Humans cardiovascular diseases 030212 general & internal medicine Intensive care medicine Adverse effect Aged Aged 80 and over Heart Failure business.industry Odds ratio Middle Aged medicine.disease Confidence interval Logistic Models Surgical Procedures Operative Heart failure Multivariate Analysis Female Surgery business Body mass index |
| Zdroj: | Journal of the American College of Surgeons. 222:1220-1229 |
| ISSN: | 1072-7515 |
| Popis: | 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; p0.001); readmission (OR 1.39, 95% CI, 1.29 to 1.50; p0.001); and 30-day mortality (OR 1.96, 95% CI 1.80 to 2.13; p0.001). 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 ventilator48 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. |
| Databáze: | OpenAIRE |
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