Maile Michael D, Engoren Milo C, Tremper Kevin K, Jewell Elizabeth, Kheterpal Sachin
From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Anesth Analg. 2014 Sep;119(3):522-532. doi: 10.1213/ANE.0000000000000116.
Heart failure (HF) is an important risk factor for perioperative morbidity and mortality. While these patients are at high risk for cardiac adverse events, there are few current data describing the types of noncardiac complications that occur in this population.
We performed a multicenter cohort study of patients undergoing noncardiac surgery from 2005 to 2010 as part of the American College of Surgeons National Surgical Quality Improvement Program. A HF cohort (HF that is new or worsening within 30 days of surgery) was compared with a control cohort that was matched regarding other surgical risk factors.
Five thousand ninety-four patients with worsening preoperative HF were compared with an otherwise similar cohort of patients without worsening preoperative HF. Worsening preoperative HF was associated with increased risk of 30-day all-cause mortality (relative risk [RR] 2.08; 95% confidence interval [CI], 1.75-2.46; P < 0.001) and increased risk of morbidity (any recorded postoperative complication) (RR 1.54; 95% CI, 1.40-1.69; P < 0.001). HF patients had increased risk of developing renal failure (RR 1.85; 95% CI, 1.37-2.49; P < 0.001), need for mechanical ventilation longer than 48 hours (RR 1.81; 95% CI, 1.52-2.15; P < 0.001), pneumonia (RR 1.73; 95% CI, 1.44-2.08; P < 0.001), cardiac arrest (RR 1.69; 95% CI, 1.29-2.21; P < 0.001), unplanned intubation (RR 1.68; 95% CI, 1.41-1.99; P < 0.001), renal insufficiency (RR 1.64; 95% CI, 1.10-2.44; P = 0.014), sepsis (RR 1.43, 95% CI, 1.24-1.64; P < 0.001), and urinary tract infection (RR 1.29; 95% CI, 1.06-1.58; P = 0.011). The incidence of myocardial infarction in the sample was similar between the 2 groups (RR 1.07; 95% CI, 0.75-1.52; P = 0.719).
Worsening preoperative HF is associated with a significant increase in postoperative morbidity and mortality when controlling for other comorbidities. Although these likely have a multifactorial etiology, patients are much more likely to suffer from respiratory, renal, and infectious complications than cardiac complications.
心力衰竭（HF）是围手术期发病和死亡的重要危险因素。虽然这些患者发生心脏不良事件的风险很高，但目前很少有数据描述该人群中发生的非心脏并发症类型。
作为美国外科医师学会国家外科质量改进计划的一部分，我们对2005年至2010年接受非心脏手术的患者进行了一项多中心队列研究。将心力衰竭队列（手术30天内新发或恶化的HF）与在其他手术风险因素方面匹配的对照队列进行比较。
将5094例术前HF恶化的患者与另一组术前HF未恶化的类似患者队列进行比较。术前HF恶化与30天全因死亡率增加（相对风险[RR]2.08；95%置信区间[CI]，1.75 - 2.46；P < 0.001）以及发病风险增加（任何记录的术后并发症）（RR 1.54；95% CI，1.40 - 1.69；P < 0.001）相关。HF患者发生肾衰竭的风险增加（RR 1.85；95% CI，1.37 - 2.49；P < 0.001）、需要机械通气超过48小时（RR 1.81；95% CI，1.52 - 2.15；P < 0.001）、肺炎（RR 1.73；95% CI，1.44 - 2.08；P < 0.001）、心脏骤停（RR 1.69；95% CI，1.29 - 2.21；P < 0.001）、非计划插管（RR 1.68；95% CI，1.41 - 1.99；P < 0.001）、肾功能不全（RR 1.64；95% CI，1.10 - 2.44；P = 0.014）、败血症（RR 1.43，95% CI，1.24 - 1.64；P < 0.001）和尿路感染（RR 1.29；95% CI，1.06 - 1.58；P = 0.011）的风险增加。两组样本中心肌梗死的发生率相似（RR 1.07；95% CI；0.75 - 1.52；P = 0.719）。
在控制其他合并症时，术前HF恶化与术后发病率和死亡率显著增加相关。虽然这些可能有多种病因，但患者发生呼吸、肾脏和感染性并发症的可能性远高于心脏并发症。
