Preoperative hypothyroidism is associated with increased morbidity and mortality following cardiac surgery: a pooled analysis
- 1Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University
- 2Department of Cardiothoracic Surgery, The Affiliated Yongchuan Hospital of Chongqing Medical University
Abstract
Introduction: The association between hypothyroidism and prognosis following cardiac surgery remains poorly understood. This study evaluated the association of preoperative hypothyroidism with postoperative complications and mortality.
Methods: PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, and Scopus were searched from inception to December 17, 2025, to identify eligible studies. Pooled odds ratios and 95% confidence intervals were calculated to assess the associations between hypothyroidism and postoperative outcomes. Subgroup and leave-one-out sensitivity analyses explored heterogeneity and assessed the stability of the findings.
Results: A total of 40,968 patients were enrolled in 22 studies for pooled analysis. For postoperative complications, more patients in the hypothyroid group developed acute kidney injury (OR = 2.61, 95% CI = 1.85 to 3.69, P = 0.00, I ² = 0.00%), myocardial infarction (OR = 1.66, 95% CI = 1.23 to 2.23, P = 0.00, I ² = 11.94%) and major adverse cardiovascular events (OR = 1.59, 95% CI = 1.45 to 1.74, P = 0.00, I ² = 0.00%). However, regarding atrial fibrillation (OR = 1.24, 95% CI = 0.89 to 1.71, P = 0.20, I ² = 71.05%), heart failure (OR = 1.46, 95% CI = 0.92 to 2.33, P = 0.11, I ² = 0.00%), and stroke (OR = 1.36, 95% CI = 0.93 to 2.00, P = 0.11, I ² = 0.00%), no statistically significant differences were observed between the two groups. As for mortality, both in-hospital mortality (OR = 1.70, 95% CI = 1.03 to 2.79, P = 0.04, I ² = 0.00%) and long-term mortality (OR = 1.70, 95% CI = 1.29 to 2.25, P = 0.00, I ² = 62.52%) were higher in the hypothyroid group. In additional analyses restricted to adjusted effect estimates, the association with heart failure reached statistical significance (aOR = 1.53, 95% CI = 1.14 to 2.04, P = 0.00, I ² = 0.00%), whereas the associations with myocardial infarction and long-term mortality were not statistically significant.
Conclusion: This study demonstrates that preoperative hypothyroidism was associated with several adverse outcomes following cardiac surgery, providing supportive evidence that surgeons should assess patients’ thyroid function and initiate appropriate interventions preoperatively.
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BibTeX
@article{dai2026preoperative,
title = {{Preoperative hypothyroidism is associated with increased morbidity and mortality following cardiac surgery: a pooled analysis}},
author = {Ruhao Dai and Jun Dong and Fei Liu and Chaofu Zhang and Linghui Peng and Xiaowen Wang and Yingjiu Jiang},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1948414},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1948414/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preoperative hypothyroidism is associated with increased morbidity and mortality following cardiac surgery: a pooled analysis
AU - Ruhao Dai
AU - Jun Dong
AU - Fei Liu
AU - Chaofu Zhang
AU - Linghui Peng
AU - Xiaowen Wang
AU - Yingjiu Jiang
PY - 2026
DA - 2026/11/09
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1948414
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1948414/full
AB - Introduction: The association between hypothyroidism and prognosis following cardiac surgery remains poorly understood. This study evaluated the association of preoperative hypothyroidism with postoperative complications and mortality. Methods: PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, and Scopus were searched from inception to December 17, 2025, to identify eligible studies. Pooled odds ratios and 95% confidence intervals were calculated to assess the associations between hypothyroidism and postoperative outcomes. Subgroup and leave-one-out sensitivity analyses explored heterogeneity and assessed the stability of the findings. Results: A total of 40,968 patients were enrolled in 22 studies for pooled analysis. For postoperative complications, more patients in the hypothyroid group developed acute kidney injury (OR = 2.61, 95% CI = 1.85 to 3.69, P = 0.00, I ² = 0.00%), myocardial infarction (OR = 1.66, 95% CI = 1.23 to 2.23, P = 0.00, I ² = 11.94%) and major adverse cardiovascular events (OR = 1.59, 95% CI = 1.45 to 1.74, P = 0.00, I ² = 0.00%). However, regarding atrial fibrillation (OR = 1.24, 95% CI = 0.89 to 1.71, P = 0.20, I ² = 71.05%), heart failure (OR = 1.46, 95% CI = 0.92 to 2.33, P = 0.11, I ² = 0.00%), and stroke (OR = 1.36, 95% CI = 0.93 to 2.00, P = 0.11, I ² = 0.00%), no statistically significant differences were observed between the two groups. As for mortality, both in-hospital mortality (OR = 1.70, 95% CI = 1.03 to 2.79, P = 0.04, I ² = 0.00%) and long-term mortality (OR = 1.70, 95% CI = 1.29 to 2.25, P = 0.00, I ² = 62.52%) were higher in the hypothyroid group. In additional analyses restricted to adjusted effect estimates, the association with heart failure reached statistical significance (aOR = 1.53, 95% CI = 1.14 to 2.04, P = 0.00, I ² = 0.00%), whereas the associations with myocardial infarction and long-term mortality were not statistically significant. Conclusion: This study demonstrates that preoperative hypothyroidism was associated with several adverse outcomes following cardiac surgery, providing supportive evidence that surgeons should assess patients’ thyroid function and initiate appropriate interventions preoperatively.
SN - 1664-2392
ER -