Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study
- Authors: STARSurg and EuroSurg collaborators Writing group (*denotes joint first authors, †denotes joint senior authors): Kouli O*, Chaudhry D*, Ooi SZY, Shafi SQ, Jakaityte I, Riad AM, Kawka M, Steinruecke M, Ko L, Gujjuri RR, El-Boghdadly K, Martin J, Biccard BM, Bhangu A, Glasbey JC, Moug S, Pinkney T, Richards T, Docherty A, Chew M, Harrison EM, McLean KA†, Kamarajah SK† Data analysis: Kouli O, Kamarajah SK, Harrison EM, McLean KA (overall guarantor) Steering Committee: Blanco-Colino R, Brindl N, Brown S, Cambridge WA, Chaudhry D, Gressmann K, Gujjuri RR, Hilder A, Jaffer A, Jakaityte I, Kamarajah SK, Kawka M, Kouli O, Matey E, McLean KA, Mergo A, Mills EC, Murray V, Ooi SZY, Pereira IS, Riad AM, Sgrò A, Shafi SQ, Trout I, Turňa A, Varghese C, Xu W External advisory group: Biccard BM, Docherty A, Martin J, El-Boghdadly K, Phull M, Mouton R, Bhangu A, Glasbey JC, Harrison EM, McLean KA, Smart N, Moug S, Pinkney T, Richards T National leads: Dajti I (Albania), de Cillia M (Austria), Van Ramshorst G (Belgium), Delibegovic S (Bosnia and Herzegovina), Mughal H (Bulgaria), Mihanovic J (Croatia), Gouvas N (Cyprus), Kocian P (Czech Republic), Levesen V (Denmark), Kaupilla J (Finland), Brindl N (Germany), Merz D (Germany), Joos M (Germany), Ioannidis A (Greece), Nnaji G (Hungary), Pata F (Italy), Pellino G (Italy), Gori A (Italy), Podda M (Italy), Riboni C (Italy), Fekaj E (Kosovo), Oliver Senica S (Latvia), Dauksa A (Lithuania), Psaila J (Malta), de Ruitjer F (Netherlands), Major P (Poland), Santos I (Portugal), Sampaio Alves M (Portugal), Simões J (Portugal), Bonci EA (Romania), Pașca A (Romania), Novikova A (Russia), Kovačević B (Serbia), Milosavljevic V (Serbia), Tadic B (Serbia), Kosir J (Slovenia), Blanco-Colino R (Spain), Pérez Ajates S (Spain), Ossola Revilla ME (Spain), Papadia A (Switzerland), Riboni C (Switzerland), Gasparri ML (Switzerland), Aktas MK (Turkey), Baki BE (Turkey), Tepe MD (Turkey), Mutlu AU (Turkey), Regional leads: United Kingdom: Singal A (Aston University Medical School); Osei-Bonsu J (Barts and The London School of Medicine and Dentistry); Lacey H (Brighton and Sussex Medical School); Chan SW (Cardiff University School of Medicine); Allison M (Hull York Medical School); Duah-Asante K (Imperial College London Faculty of Medicine); Chen D (Keele University School of Medicine); Ahmed N (King’s College London GKT School of Medical Education); Ejiz A (Lancaster University Medical School); Takyi C (Newcastle University School of Medical Education); Mujeeb M (Plymouth University Peninsula Schools of Medicine and Dentistry); Ravikumar N (Queen’s University Belfast School of Medicine); Khan M (Royal College of Surgeons in Ireland School of Medicine); Hayes J (St George’s, University of London); Mckenna J (Swansea University Medical School); Wang J (The University of Edinburgh Medical School); Essa N (Trinity College Dublin School of Medicine); Xianghan H (University College Cork School of Medicine); Ko L (University College Dublin School of Medicine); Aldabbagh Y (University College London Medical School); Plascevic J (University of Aberdeen School of Medicine and Dentistry); Zia N (University of Birmingham College of Medical and Dental Sciences); Ismail R (University of Bristol Medical School); Kamel Y (University of Buckingham Medical School); Epanomeritakis I (University of Cambridge School of Clinical Medicine); Tan R (University of Dundee School of Medicine); Chiu N (University of Exeter Medical School); Naeem A (University of Glasgow School of Medicine); Kakwani M (University of Leeds School of Medicine); Mehra R (University of Leicester Medical School); Feeney K (University of Limerick School of Medicine); Yan Naing CL (University of Liverpool School of Medicine); Qureshi A (University of Manchester Medical School); Richens A (University of Nottingham School of Medicine); Li H (University of Oxford Medical Sciences Division); A
- Publication year: 2024
- Type: Articolo in rivista
- Key words: abdominal surgery; cardiovascular complications; cohort study; mortality; postoperative
- OA Link: http://hdl.handle.net/10447/644153
Abstract
Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. We performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The primary outcome measure was cardiovascular complications as defined by the Standardised Endpoints for Perioperative Medicine-Core Outcome Measures for Perioperative and Anaesthetic Care initiative up to 30 days after surgery. The secondary outcome was 30-day postoperative mortality. This study included 24,203 patients, of whom 611 (2.5%) developed cardiovascular complications. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were judged to be cardiac-related. Mortality rates were higher in patients who developed postoperative cardiovascular complications than in those who did not (19.8% vs. 1.4%), which persisted after risk adjustment (hazard ratio (95%CI) 4.15 (3.14-5.48)). We estimated an absolute risk reduction (95%CI) of 0.4 (0.3-0.5) in mortality in the absence of all cardiovascular complications. This would confer a relative risk reduction in mortality of 21.1% if all cardiovascular complications were prevented. Postoperative cardiovascular complications are relatively common and occur early after major abdominal surgery. However, over 1 in 5 postoperative deaths were attributable to these complications, highlighting an important area for future randomised trials.