BACKGROUND The accurate diagnosis of heart failure (HF) before major noncardiac surgery is frequently challenging. The impact of diagnostic accuracy for HF on intraoperative practice patterns and clinical outcomes remains unknown. METHODS We performed an observational study of adult patients undergoing major noncardiac surgery at an academic hospital from 2015 to 2019. A preoperative clinical diagnosis of HF was defined by keywords in the preoperative assessment or a diagnosis code. Medical records of patients with and without HF clinical diagnoses were reviewed by a multispecialty panel of physician experts to develop an adjudicated HF reference standard. The exposure of interest was an adjudicated diagnosis of heart failure. The primary outcome was volume of intraoperative fluid administered. The secondary outcome was postoperative acute kidney injury (AKI). RESULTS From 40 659 surgeries, a stratified subsample of 1018 patients were reviewed by a physician panel. Among patients with adjudicated diagnoses of HF, those without a clinical diagnosis (false negatives) more commonly had preserved left ventricular ejection fractions and fewer comorbidities. Compared with false negatives, an accurate diagnosis of HF (true positives) was associated with 470 ml (95% confidence interval: 120-830; P=0.009) lower intraoperative fluid administration and lower risk of AKI (adjusted odds ratio:0.39, 95% confidence interval 0.18-0.89). For patients without adjudicated diagnoses of HF, non-HF was not associated with differences in either fluids administered or AKI. CONCLUSIONS An accurate preoperative diagnosis of heart failure before noncardiac surgery is associated with reduced intraoperative fluid administration and less acute kidney injury. Targeted efforts to improve preoperative diagnostic accuracy for heart failure may improve perioperative outcomes.

中文翻译：

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心力衰竭诊断准确性、术中液体管理和术后急性肾损伤：一项单中心前瞻性观察研究。


背景 在非心脏大手术前准确诊断心力衰竭 （HF） 通常具有挑战性。HF 诊断准确性对术中实践模式和临床结局的影响仍然未知。方法 我们对 2015 年至 2019 年在一家学术医院接受大型非心脏手术的成年患者进行了观察性研究。HF 的术前临床诊断由术前评估中的关键字或诊断代码定义。由医师专家组成的多学科小组审查了有和没有 HF 临床诊断的患者的病历，以制定判定的 HF 参考标准。感兴趣的暴露是心力衰竭的判定诊断。主要结局是术中液体给药量。次要结局是术后急性肾损伤 （AKI）。结果 从 40 659 例手术中，医生小组审查了 1018 例患者的分层子样本。在确诊为 HF 的患者中，无临床诊断 （假阴性） 的患者更常保留左心室射血分数和较少的合并症。与假阴性相比，HF 的准确诊断 （真阳性） 与 470 ml 相关 （95% 置信区间： 120-830;P=0.009） 术中液体给药较低，AKI 风险较低 （校正比值比： 0.39,95% 置信区间 0.18-0.89）。对于未确诊为 HF 的患者，非 HF 与给药液体或 AKI 的差异无关。结论 非心脏手术前对心力衰竭的准确术前诊断与术中液体给药减少和急性肾损伤减少相关。 有针对性地提高心力衰竭术前诊断的准确性可能会改善围手术期结局。