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Risk for postoperative congestive heart failure
M E Charlson1, C R MacKenzie, J P Gold
1Department of Medicine, Cornell University Medical College, New York, New York 10021.
Insights
Preoperative cardiac disease and diabetes are key predictors of postoperative congestive heart failure (CHF). Intraoperative blood pressure fluctuations increase CHF risk, while adequate fluid intake may reduce it.
Area of Science:
- Cardiology
- Anesthesiology
- General Surgery
Background:
- Postoperative congestive heart failure (CHF) is a significant complication, particularly in high-risk patients.
- Identifying predictors is crucial for risk stratification and management in elective surgeries.
Purpose of the Study:
- To identify predictors of postoperative congestive heart failure (CHF) in patients undergoing elective general operations.
- To assess the impact of preoperative conditions and intraoperative parameters on CHF development.
Main Methods:
- A study of 254 patients, focusing on those with hypertension and diabetes.
- Analysis of preoperative cardiac status, diabetes, intraoperative mean arterial pressure (MAP) fluctuations, and fluid balance (net intake).
Main Results:
- Postoperative CHF occurred in 6% of patients.
- Patients with preoperative cardiac disease had a significantly higher incidence (17%) compared to those without (<1%).
- Diabetic patients had increased risk (12%), especially if they also had cardiac disease.
- Large intraoperative MAP fluctuations (≥40 mmHg change) correlated with increased CHF risk (p<0.02).
- Low net fluid intake (<500 mL/hr) was associated with higher failure rates (p<0.03).
Conclusions:
- Risk for postoperative CHF is concentrated in patients with symptomatic preoperative cardiac disease, particularly when combined with diabetes.
- Intraoperative MAP variability is an independent risk factor for postoperative CHF.
- Adequate intraoperative fluid administration appears to be protective against postoperative CHF.
Abstract:
To identify predictors of postoperative congestive heart failure (CHF), a high-risk population, mainly hypertensive and diabetic patients undergoing elective general operations, was studied. Of the 254 patients, 6 per cent had postoperative CHF. Among patients with preoperative cardiac disease (that is, previous myocardial infarction, valvular disease or CHF), 17 per cent had postoperative CHF; in contrast with less than 1 per cent of those without cardiac disease (p less than 0.001). Patients with diabetes were also at high risk (12 versus 2 per cent, p less than 0.005), particularly those with cardiac disease. Patients who had equal to or greater than 40 millimeters of mercury increases or decreases intraoperatively in mean arterial pressure in relation to preoperative baseline had increased postoperative failure rates (p less than 0.02). Of note, postoperative failure rates were highest among patients with less than 500 milliliters per hour of net intake (input and output) (p less than 0.03). Risk for postoperative CHF was restricted to patients with preoperative symptomatic cardiac disease and was especially high if patients also had diabetes. Intraoperative fluctuations in mean arterial pressure increased the probability of postoperative failure, while the intraoperative administration of higher net volumes of fluid was associated with decreased risk.