Purpose The risks and outcomes of nontransplant patients with noncardiac surgeries have been well reported. However, the risks and outcomes associated with noncardiac surgeries in the heart transplantation population are less well established. Heart transplant patients have unique cardiac physiology secondary to the denervated heart and have specific immunosuppression needs, which may all increase perioperative outcomes.
Methods Between 1994 and 2002, 482 heart transplant patients were reviewed at our institution for those undergoing elective noncardiac surgeries and their perioperative outcomes. Patients on maintenance corticosteroids were given stress corticosteroid doses in the form of intravenous hydrocortisone perioperatively. For patients who could not tolerate oral calcineurin inhibitors postoperatively, the appropriate intravenous dose was administered.
Results Seventy-three of 482 patients underwent 104 noncardiac surgeries; 68% were male, average age 58 years, and 63% were overweight (BMI > 25). There were 16 vascular surgeries, including 3 abdominal aortic aneurysm repairs. Forty-eight (46%) were inpatients and 56 (54%) were outpatients. There were 2 (2.7%) deaths during hospitalization associated with the nonvascular surgeries (ovarian cancer, neurosurgery). In-hospital morbidities included the following: 9 infections or 18.8% of hospitalized patients (2 chest infections, 6 wound infections, and 1 brain abscess) within 30 days of surgery and 1 patient (2%) with congestive heart failure. Of the 104 noncardiac surgeries, 61 (58.6%) used general anesthesia, 25 (24%) used local anesthesia, 2 (1.9%) used spinal anesthesia, 11 (10.6%) used monitored anesthesia care, and 5 (4.8%) used epidural. Readmission due to the operation was seen in 4 patients, and readmission not related to the operation was seen for 2 patients.
Conclusions Even in an experienced heart transplant center, noncardiac surgery following heart transplantation is associated with an increased postoperative infection risk, likely related to the immunosuppressed state and elevated BMI.
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