Gender and Racial Differences in Surgical Outcomes in Patients With HF

Study Questions:

Are non-cardiac surgical outcomes different between men and women and Blacks and Whites with new and chronic acutely decompensated heart failure (HF)?

Methods:

A secondary analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) registry was conducted to compare morbidity and mortality surgical outcomes in patients with new and chronic acute, worsening HF who underwent non-cardiac surgery in 2012-2013. Eighteen prospectively defined NSQIP complications that occurred within 30 days after surgery were examined for ethnic and gender differences, along with hospital readmissions and mortalities. Univariate analyses were performed, and multivariate regression models were used to examine ethnic and gender disparities.

Results:

The sample consisted of 9,548 surgical patient cases (54% men and 46% women; 72% White, 15% Black, and 13% other or unknown ethnic backgrounds). No gender differences in mortality were found; however, overall death rates were four times higher than by the ACS NQSIP prediction models (13% mortality in men and 13% in women). Women were more likely to receive blood products and be treated for urinary tract infection, and men were more likely to have a cardiac arrest, myocardial infarction, or prolonged mechanical ventilation (>48 hours). Black patients with HF were more likely to be re-intubated, experience renal failure and sepsis, and be readmitted within 30 days of surgery but had lower rates of septic shock compared with White patients with HF after adjusting for demographics, comorbidities, and laboratory values.

Conclusions:

No gender differences in mortality were found; however, White patients died more often than Black patients within 30 days post-operatively. Although no ethnic differences in post-operative complications and morbidity were found, significant differences in post-operative complications and morbidities were found between men and women and warrant further study.

Perspective:

Findings from this study offer insight into general and vascular (non-cardiac) surgery morbidity and mortality outcomes from prospectively collected data of 300 US hospitals (community and university hospitals). Because HF was narrowly defined within the ACS NSQIP system, and because HF-specific data (e.g., ejection fraction) were not collected, interpretation and translation in practice is limited. Variables such as HF medications, illness acuity/disease severity, and ejection fraction are needed to confirm or refute equivalent findings in mortality and differences in complications in the current study sample.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, General Surgery, European Continental Ancestry Group, African Americans, Male, Female, Shock, Septic, Patient Readmission, Myocardial Infarction, Morbidity, Renal Insufficiency, Sepsis


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