Patient-centered outcomes according to cancer status in cardiac surgery patients: a population-based cohort study

More cancer survivors are undergoing cardiac surgery, but their postoperative outcomes remain poorly understood. We aimed to describe the incidence and predictors of postoperative major adverse cardiovascular events (MACE) and patient-defined cardiovascular and non-cardiovascular events (PACE) by cancer status.

We conducted a retrospective cohort study (2016-2022) among U.S. adults (≥18 years) undergoing cardiac surgery in MarketScan and Medicare databases. Co-primary outcomes were MACE (stroke, heart failure, myocardial infarction, repeat revascularization) and PACE (stroke, heart failure, new-onset dialysis, long-term care admission, ventilator-dependence). Cox regression evaluated the association of cancer status with postoperative outcomes.

Among 61,581 patients (74.1% male; mean age 61 ± 10.9 years), 5381 (8.7%) had cancer. Although cancer patients exhibited higher unadjusted MACE and PACE over 2.0 ± 1.7 years (p < 0.001), multivariable analyses showed no significant association between cancer status and MACE or PACE at 30-days or at long-term follow-up MACE (aHR 1.05, 95%CI [0.99-1.10]) and PACE (aHR 1.02, [0.96-1.08]). Blood (aHR 1.13, [1.01-1.26]) and lung cancers (aHR 1.32, [1.08-1.62]) were associated with increased MACE risk, while digestive (aHR 1.17, [1.00-1.36]) and blood (aHR 1.14, [1.01-1.28]) cancers were linked to higher PACE risk. Factors more strongly predictive of PACE than MACE included older age, female sex and valvular/complex surgeries.

Cancer status alone should not preclude cardiac surgery. A personalised, multidisciplinary approach may help optimise outcomes and better manage risks in this high-risk population.