DOI: 10.1093/bjs/znad258.047 ISSN:

751 Incidence and Risk Factors of Postoperative Cardiac Complications: An International Prospective Cohort Study

D Chaudhry
  • Surgery



Postoperative cardiac complications (PCC) after major surgery remain heterogeneously reported. This international prospective cohort study aimed to define incidence and risk factors for PCC after major abdominal surgery in Europe, Ireland, and UK.


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 postoperative cardiac complications (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.


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.


PCC are infrequent after major abdominal surgery, yet death from cardiac causes was higher than previously reported in adults undergoing major abdominal surgery. Targeting high-risk groups at risk of PCC and death warrant holistic interventional trials as future research focus.

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