O035 Incidence, timing and risk factors of postoperative cardiac complications: an international prospective cohort study

Abstract

Abstract Introduction Postoperative cardiac complications (PCC) have been associated with increased risk of death after major surgery, however, PCC remain heterogeneously reported in trials. This international prospective cohort study aimed to define incidence and risk of PCC after major abdominal surgery in Europe, Ireland, and UK. Methods A prospective, international cohort study was performed between January 23 and May 1, 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries of Europe. The primary outcome was PCC as defined by Standardised Endpoints and COMs for Perioperative and Anaesthetic Care (StEP-COMPAC) to 30-days after surgery. The secondary outcome was 30-day postoperative mortality. Multilevel logistic regression was used to adjust for risk factors associated with PCC rates. Results This study included 24,260 patients, of whom 611 (2.5%) developed PCC and 458 (1.9%) died within 30-days of surgery. Of patients who died, 123 (26.9%) were related to cardiac causes. Mortality rates were higher in patients who developed PCC than those who did not (19.8% vs 1.4%, p<0.001). On adjusted analyses, age >65 years (OR: 2.47, 95% CI: 1.99-3.06), ASA grade III-V (OR: 1.95, 95% CI: 1.58 - 2.40), emergency surgery (OR: 1.62, 95% CI: 1.31 - 2.00), and contaminated/dirty surgery (OR: 1.60, 95% CI: 1.15 - 2.23) were risk factors for PCC. Conclusion PCC are infrequent but occur early after major abdominal surgery. Death from cardiac causes were higher than previously reported. Identification of groups at high-risk of PCC and death for risk-reduction strategies is warranted.