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Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish
Javier Marco-Martínez1, Francisco Javier Elola-Somoza2, Cristina Fernández-Pérez2,3
1Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Universidad Complutense, 28040 Madrid, Spain.
Insights
Heart failure (HF) significantly increases in-hospital mortality and hospital stay for patients undergoing cholecystectomy. However, outcomes improved for both HF and non-HF patients over the study period.
Area of Science:
- Cardiovascular Medicine
- Surgical Outcomes Research
- Public Health
Background:
- Global aging population drives increased cholecystectomy incidence.
- Investigating the impact of heart failure (HF) on surgical outcomes is crucial.
Purpose of the Study:
- To determine the influence of heart failure (HF) on in-hospital outcomes for patients undergoing cholecystectomy within the Spanish National Health System (SNHS).
Main Methods:
- Retrospective analysis of the Spanish National Hospital Discharge Database (2007-2015).
- Inclusion of patients over 17 years undergoing cholecystectomy.
- Collection of demographic, disease, and procedure-related data.
Main Results:
- 474,754 cholecystectomy episodes analyzed; 0.89% had HF.
- HF patients were older and experienced higher complication rates (p < 0.001), except stroke.
- In-hospital mortality (12.9% vs 1%) and hospital stay (16.2 vs 5.3 days) were significantly higher in the HF group (p < 0.001).
Conclusions:
- Heart failure presence elevates in-hospital mortality and prolongs hospital stay post-cholecystectomy.
- Significant decreases in mortality and hospital stay observed for both HF and non-HF patients during the study period.
- Risk-adjusted models indicate substantial outcome variability among hospitals.
Background:
The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS).
Methods:
We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007-2015 were included. Demographic and administrative variables related to patients' diseases as well as procedures were collected.
Results:
478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models' discrimination was high in both cases, with AUROC values = 0.963 (0.960-0.965) in the APRG-DRG model and AUROC = 0.965 (0.962-0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals.
Conclusions:
The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).
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