Non-cardiac surgeries in adults with congenital heart disease -influence of complexity of disease and estimated risk of surgery on adverse events.

Abstract

Background: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality.

Methods: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD.

Results: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD.

Conclusions: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.