An increasing number of cancer survivors are undergoing cardiac surgery, but their postoperative cardiovascular and non-cardiovascular outcomes remain incompletely defined. This retrospective cohort study published in the British Journal of Cancer analyzed data from U.S. adults aged ≥18 years who underwent cardiac surgery between 2016 and 2022 using MarketScan and Medicare databases. 

Cancer status was assessed to evaluate its association with postoperative outcomes. Co-primary endpoints were MACE (major adverse cardiovascular events: stroke, heart failure [HF], myocardial infarction [MI], repeat revascularization) and PACE (patient-defined cardiovascular and non-cardiovascular events: stroke, HF, new-onset dialysis, long-term care admission, ventilator dependence)

Among 61,581 patients, 5381 (8.7%) had a history of cancer. The cohort had a mean age of 61±10.9 years, and 74.1% were male. Over a mean follow-up of 2.0±1.7 years, cancer patients had higher unadjusted rates of MACE and PACE (p < 0.001). 

However, after multivariable adjustment, cancer status was not significantly associated with MACE (adjusted hazard ratio [aHR] 1.05; 95% CI, 0.99-1.10) or PACE (aHR 1.02; 95% CI, 0.96-1.08) at 30 days or long-term follow-up. Subgroup analyses showed higher MACE risk among patients with blood (aHR 1.13; 95% CI, 1.01-1.26) and lung cancers (aHR 1.32; 95% CI, 1.08-1.62), and higher PACE risk among those with digestive (aHR 1.17; 95% CI, 1.00-1.36) and blood cancers (aHR 1.14; 95% CI, 1.01-1.28). Older age, female sex, and valvular or complex surgeries were more strongly predictive of PACE than of MACE.

These findings suggest that cancer status alone may not independently affect the risk of postoperative cardiovascular or patient-centered adverse events after cardiac surgery. A multidisciplinary, individualized care approach may help optimize management in this patient population.