Journal of Anesthesia

, Volume 32, Issue 5, pp 663–672 | Cite as

Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis

  • Ryu KomatsuEmail author
  • Nika Karimi
  • Nicole M. Zimmerman
  • Daniel I. Sessler
  • C. A. Bashour
  • Edward G. Soltesz
  • Alparslan Turan
Original Article



To determine whether hypothyroidism is associated with cardiovascular complications and surgical wound infections after cardiac surgery.


Patients were categorized as: (1) hypothyroid [patients with increased TSH concentrations (≧ 5.5 mIU/L) within 6 months prior to surgery]; (2) corrected hypothyroid [diagnosis of hypothyroidism any time before surgery or on preoperative thyroid supplementation and normal TSH concentration (0.4 \(\le\) TSH \(\le\) 5.5 mIU/L]; and (3) euthyroid [no hypothyroid diagnosis and not on preoperative thyroid supplementation and normal TSH concentrations (0.4–5.5 mIU/L)]. We conducted pairwise comparisons among the three groups using inverse probability of treatment weighting. We compared the groups on postoperative myocardial infarction, cardiac arrest, atrial fibrillation, and a composite of surgical wound infections and postoperative vasopressor use using multivariable logistic regression models. We compared the groups on ICU and hospital length of stay using Cox proportional hazards regression.


Hypothyroidism was associated with a lower risk of atrial fibrillation than euthyroidism, with an estimated relative risk (99.4% CI) of 0.71 (0.56, 0.89); P < 0.001. However, none of the other pairwise comparisons on myocardial infarction, cardiac arrest, and atrial fibrillation were significant. Corrected hypothyroid patients were slightly more likely to be discharged from hospital at any given time than euthyroid patients (hazard ratios (99.6% CI), 1.18 (1.07, 1.30); P < 0.001), but no other pairwise comparisons for secondary outcomes were significant.


Hypothyroidism was associated with lower risk of atrial fibrillation than euthyroidism, and corrected hypothyroidism was associated with a shorter length of stay than euthyroidism.


Hypothyroidism Cardiac surgical procedures Postoperative complications 



Financial support and sponsorship: Support was provided solely from institutional and/or departmental sources.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 36 KB)
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Supplementary material 2 (DOCX 19 KB)
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Supplementary material 3 (DOCX 71 KB)
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Supplementary material 4 (DOCX 26 KB)


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of Outcomes Research, Anesthesiology InstituteCleveland ClinicClevelandUSA
  3. 3.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA
  4. 4.Department of Outcomes ResearchCleveland ClinicClevelandUSA
  5. 5.Department of Outcomes Research, Anesthesiology InstituteCleveland ClinicClevelandUSA
  6. 6.Department of Cardiothoracic Anesthesiology, Anesthesiology InstituteCleveland ClinicClevelandUSA
  7. 7.Department of Cardiovascular SurgeryCleveland ClinicClevelandUSA

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