Cardiac Complications of Major Elective Non-Cardiac Surgery: Incidence and Risk Factors

Abstract

Previous estimates of the incidence of cardiac complications following major elective surgery have all been obtained in populations with specific risk factors or in contexts that differ from those found in Spain. Our aims were to estimate the frequency of postoperative cardiac complications following major elective non-cardiac surgery in patients aged 40 years or more, and to identify associated risk factors. Prospective observational study of consecutive patients undergoing surgery between November 1997 and October 1999. The overall incidence of postoperative cardiac complications was 9.6 (95% CI, 5.3-16): it was 1.9 (95% CI, 0.5-7.5) for superficial surgery, 36.2 (95% CI, 15.1-87) for deep surgery, and 150 (95% CI, 67.4-334) for peripheral vascular surgery. The risk of cardiac complications was greater in patients aged 75 years or more (relative risk [RR]=9.5; 95% CI, 2.6-34.9), in those with type-I diabetes (RR=7.1; 95% CI, 2.1-24.1), systolic blood pressure > or =180 mmHg (RR=5.8; 95% CI, 1.3-25.4), or electrocardiographic signs of ischemia (RR=25.3; 95% CI, 6-106.8), in those who had undergone deep or peripheral vascular surgery (RR=21; 95% CI, 5.4-81.6), and in those who experienced hypotensive episodes during surgery (RR=8.9; 95% CI, 2-39.1). Cardiac complications occurred in 1% of consecutive patients aged 40 years or more in the three months following major elective non-cardiac surgery.