Thirty-day postoperative cardiopulmonary complications in sarcoidosis: Insights from a retrospective matched cohort analysis

Abstract

Purpose

Sarcoidosis is a rare systemic granulomatous disorder characterized by lung involvement but frequently involves the heart, gastrointestinal and lymphatic organs. Few studies have investigated sarcoidosis-related postoperative cardiopulmonary complications, creating a significant knowledge gap. Using a comparative cohort analysis, the authors hypothesized that sarcoidosis would be associated with higher risk for 30-day postoperative pulmonary complications (PPC).

Methods

This retrospective study examined hospital system data between January 1, 2013, and January 1, 2022, for patients over 18 years, admitted for procedural intervention. 389 sarcoidosis patients and controls (N = 48,823) were identified. The primary endpoint of PPC, as measured by the Agency for Healthcare Research and Quality PPC composite, and secondary endpoints of major adverse cardiovascular events (MACE), PPC subcomposites, and length of stay (LOS) were analyzed. A Mahalanobis distance matching (MDM) was used to match sarcoidosis and control patients (N = 389) on clinically relevant baseline covariates.

Results

After MDM and adjustment for surgical time and anesthesia type, sarcoidosis diagnosis corresponded to higher composite 30-day PPC (18.5% vs. 9.3%, adjusted odds ratio [OR_adj] = 3.32, 95% confidence intervals [CI] 1.8–5.8; p < 0.001), sub-composite respiratory failure/insufficiency (10.5% vs. 5.1%, OR_adj = 3.31, 95% CI 1.6–6.7; p < 0.001) but not pneumonia (5.7% vs. 3.9%, OR_adj = 2.0, 95% CI 0.8–4.8; p = 0.117). The sarcoidosis cohort had longer LOS (OR_adj = 2.33, 95% CI 2.0–2.7; p < 0.001). Sarcoidosis diagnosis was not associated with 30-day MACE (12.3% vs. 12.9%, OR_adj = 1.43, 95% CI 0.8–2.4; p = 0.192), atrial fibrillation (6.9% vs. 5.7%; p = 0.931), or congestive heart failure events (5.9% vs. 7.2%; p = 0.526).

Conclusions

Sarcoidosis is associated with a twofold increased risk of 30-day PPC, primarily related to an increased incidence of 30-day respiratory failure/insufficiency. This risk appears to be independent of disease staging, but is associated with the presence of sarcoidosis features on preoperative chest radiography. Postoperatively, sarcoidosis patients experience longer hospital LOS, suggesting that when complications occur, they are more resource-intensive, when compared to controls. These findings highlight opportunities to enhance preoperative multi-disciplinary optimization, and suggest that tailored perioperative care strategies for sarcoidosis patients would be beneficial.

Graphical Abstract