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

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Abstract

Purpose

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

Methods

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.

Results

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.

Conclusions

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

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA, 98195, USA

    Ryu Komatsu

  2. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

    Nika Karimi

  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Nicole M. Zimmerman

  4. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    Nicole M. Zimmerman

  5. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

    Daniel I. Sessler & Alparslan Turan

  6. Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

    C. A. Bashour

  7. Department of Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA

    Edward G. Soltesz

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  1. Ryu Komatsu
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  2. Nika Karimi
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  3. Nicole M. Zimmerman
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  4. Daniel I. Sessler
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Correspondence to Ryu Komatsu.

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Komatsu, R., Karimi, N., Zimmerman, N.M. et al. Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis. J Anesth 32, 663–672 (2018). https://doi.org/10.1007/s00540-018-2533-5

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  • DOI: https://doi.org/10.1007/s00540-018-2533-5

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