In the Journals

Mortality risk increases after elective noncardiac surgery in women with HF

Sherry M. Wren

Women with HF have significantly greater odds of mortality after elective noncardiac operations than men with HF; however, both are at greater risk than patients who do not have HF at all, according to findings published in JAMA Network Open.

Researchers found that the odds of postoperative mortality were higher among women with HF (adjusted OR = 2.44; 95% CI, 1.73-3.45) than men (aOR = 1.64; 95% CI, 1.54-1.74). According to the study, this finding suggests that HF may negate any protective association between female sex and postoperative mortality (P = .03).

Moreover, female sex was not independently associated with 90-day postoperative mortality, compared with male sex, among patients with HF (aOR = 0.97; 95% CI, 0.71-1.32), according to the findings of the study. These results were consistent across all levels of left ventricular ejection fraction.

“The impact on clinical practice is to have cardiologists, surgeons and anesthesiologists understand the increased risk of mortality in patients with heart failure, even when they have preserved ejection fractions in both genders,” Sherry M. Wren, MD, FACS, vice chair and professor of surgery at the Stanford University School of Medicine, told Healio. “Specifically, in women with heart failure, their risks can be underappreciated since they are typically younger, on fewer medications and have preserved systolic function. Understanding the risks help in maximizing perioperative strategies to optimize patients before surgery, monitor them afterward and do better informed consent.”

In this multisite cohort study, researchers used data from the U.S. Department of Veterans Affairs Surgical Quality Improvement Project database to determine whether the risk for postoperative mortality is associated with sex among patients with HF who underwent noncardiac operations from October 2009 to September 2016. According to the study, researchers assessed 609,735 patients in total, of whom 7.9% had HF (mean age, 68.6 years; 3% women) and 92.1% did not (mean age, 59.4 years; 9.1% women). The primary outcome was postoperative mortality at 90 days.

“Overall, the risk of heart failure and surgery is underappreciated by most physicians unless the patients have clinical symptoms or very low ejection fractions. This lack of understanding and awareness results in patients not being informed of their increased risks and loss of opportunity to look for strategies to diminish the risks,” Wren told Healio in an interview. “I was surprised by the results because in almost every disease or condition studied, women have a survival advantage over men. We are currently trying to identify modifiable patient factors to potentially lower postoperative mortality risks.” – by Scott Buzby

Disclosures: Wren and the other authors report no relevant financial disclosures.

Sherry M. Wren

Women with HF have significantly greater odds of mortality after elective noncardiac operations than men with HF; however, both are at greater risk than patients who do not have HF at all, according to findings published in JAMA Network Open.

Researchers found that the odds of postoperative mortality were higher among women with HF (adjusted OR = 2.44; 95% CI, 1.73-3.45) than men (aOR = 1.64; 95% CI, 1.54-1.74). According to the study, this finding suggests that HF may negate any protective association between female sex and postoperative mortality (P = .03).

Moreover, female sex was not independently associated with 90-day postoperative mortality, compared with male sex, among patients with HF (aOR = 0.97; 95% CI, 0.71-1.32), according to the findings of the study. These results were consistent across all levels of left ventricular ejection fraction.

“The impact on clinical practice is to have cardiologists, surgeons and anesthesiologists understand the increased risk of mortality in patients with heart failure, even when they have preserved ejection fractions in both genders,” Sherry M. Wren, MD, FACS, vice chair and professor of surgery at the Stanford University School of Medicine, told Healio. “Specifically, in women with heart failure, their risks can be underappreciated since they are typically younger, on fewer medications and have preserved systolic function. Understanding the risks help in maximizing perioperative strategies to optimize patients before surgery, monitor them afterward and do better informed consent.”

In this multisite cohort study, researchers used data from the U.S. Department of Veterans Affairs Surgical Quality Improvement Project database to determine whether the risk for postoperative mortality is associated with sex among patients with HF who underwent noncardiac operations from October 2009 to September 2016. According to the study, researchers assessed 609,735 patients in total, of whom 7.9% had HF (mean age, 68.6 years; 3% women) and 92.1% did not (mean age, 59.4 years; 9.1% women). The primary outcome was postoperative mortality at 90 days.

“Overall, the risk of heart failure and surgery is underappreciated by most physicians unless the patients have clinical symptoms or very low ejection fractions. This lack of understanding and awareness results in patients not being informed of their increased risks and loss of opportunity to look for strategies to diminish the risks,” Wren told Healio in an interview. “I was surprised by the results because in almost every disease or condition studied, women have a survival advantage over men. We are currently trying to identify modifiable patient factors to potentially lower postoperative mortality risks.” – by Scott Buzby

Disclosures: Wren and the other authors report no relevant financial disclosures.