Cardiac disease in the non-cardiac surgical population: effect on survival

Mortality from cardiac disease is decreasing, yet the prevalence of ischemic heart disease, diabetes and hypertension is increasing. This, combined with an aging population, affects the characteristics of the surgical population. Survival in this subgroup of the non-cardiac surgical population has not been studied in a UK setting. This study aimed to determine the mortality rate at 1, 6 and 24 months for patients with underlying cardiac risk factors undergoing elective non-cardiac surgery, and to identify independent risk factors associated with 1-year mortality (death within 365 days of original operation date). Following ethical approval, 1622 patients were included in the study. Demographic, pre-, peri- and postoperative variables were collected from medical and nursing notes. Follow-up was completed using the National Office of Statistics tracking system. Copies of death certificates were obtained on all patients who had died within 12 months of surgery. Risk factors for 1-year mortality were identified using multiple regression modelling. Survival at 12 months was 89%. The majority of cardiac-related deaths occurred within the first 6 months of surgery. Independent risk factors associated with 1-year mortality were advanced age, preoperative angina, odds ratio=1.59 (1.02-2.47), surgery type, perioperative blood transfusion and a prolonged hospital stay. A significant portion of the non-cardiac surgical population who have underlying cardiac disease risk factors are at risk of a cardiac-related death within 1 year of surgery. Patients with angina had nearly a 60% greater risk of death compared with asymptomatic patients. In the hospital setting, nurses with the appropriate pre-assessment and critical care competencies are pivotal to the successful management of this group of patients. In the long term, careful follow-up by the primary care team can help modify cardiac risk factors and potentially reduce cardiac-related mortality.