Association of the cardiovascular-kidney-metabolic syndrome and adverse outcomes after noncardiac surgery.

Abstract

Fifteen percent of US adults have advanced stages of the cardiovascular-kidney-metabolic (CKM) syndrome. The association between advanced stages of CKM and adverse surgical outcomes is not well established. This retrospective cohort study used US Medicare data between 2017 and 2020 for patients ≥65 yr old who underwent major noncardiac surgery. Multivariable logistic regression was used to examine the association between CKM stages and the primary outcome, major adverse cardiovascular events (MACE). Secondary outcomes were mortality and non-home discharges. Disparities by race, ethnicity, and sex were also examined. Among 2 129 997 surgeries (mean age: 75 yr [65-112]; 52% female), 274 574 (12.9%) were undertaken in patients with CKM Stage 0 (no risk factors). CKM Stage 3 (subclinical cardiovascular disease) was recorded in surgeries involving 37 031 individuals (1.74%); 537 894 (25.3%) surgeries were undertaken in individuals with Stage 4 CKM (established cardiovascular disease, with metabolic risk factors, chronic kidney disease, or both). Advanced stages of CKM ≥3 were independently associated with increased risk of MACE (adjusted odds ratio [AOR] range: 1.70-3.42), mortality (AOR range: 1.52-3.61), and non-home discharge (AOR range: 1.98-4.25), compared with patients without CKM (all P<0.001). Black, Hispanic, and female individuals did not have a higher risk of MACE compared with White or male individuals with the same CKM stage. Advanced stages of CKM were associated with a higher risk of major adverse cardiovascular events, mortality, and non-home discharge, but this was unrelated to race, ethnicity, or sex.