Patients with heart failure are at an increased risk of experiencing postoperative adverse events and mortality. While ambulatory surgical procedures are perceived as being low risk, morbidity and mortality outcomes in this surgical setting have not been well studied. In this retrospective cohort study, 355,121 adult patients with and without heart failure undergoing ambulatory, elective, non-cardiac surgery in the Veterans Affairs Surgical Quality Project database (2009-2016) were followed up to study post-operative complications at 30 days and post-operative mortality at 90 days. Of the patients studied, 19,353 patients were identified as having heart failure (5.5%). Researchers found that patients with heart failure were at a higher risk of 90-day mortality (OR 1.95, 95% CI 1.69 to 2.44), with mortality increasing with decreasing systolic function. This risk was pronounced in patients with symptomatic heart failure (OR 2.76, 95% CI 2.07 to 3.70), but also observed in patients with asymptomatic heart failure (OR 1.85, 95% CI 1.60 to 2.15). The risk of experiencing a postoperative complication within 30 days was also increased in patients with heart failure (OR 1.10, 95% CI 1.02 to 1.19). This study therefore shows that patients with heart failure undergoing ambulatory, elective, non-cardiac surgery are at an increased risk of experiencing postoperative morbidity and mortality.
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