Factors and Outcomes Associated With Cardiac Complications Among Patients Undergoing Elective Major Abdominal Surgery

Background Among patients undergoing major abdominal surgery (MAS), ∼3% develop cardiac complications (CC) and face poorer prognosis. This study aimed to characterize outcomes and identify factors associated with CC following MAS. Methods All elective adult (>17) hospitalizations for MAS (colectomy, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy) were identified in the 2016-2022 National Inpatient Sample, using survey weights to generate nationally representative estimates. The primary outcome of interest was the development of CC (acute myocardial infarction (AMI) and cardiac arrest). We also evaluated patient and institutional factors associated with failure-to-rescue (FTR) following CC. Risk-adjusted analyses with multivariable regressions were used to characterize factors associated with the development of CC. Subgroup analyses were conducted for isolated AMI and cardiac arrest. Results Of an estimated 904 270 patients, 1.8% developed CC. Compared to others, CC were older (71 vs 62 years), less commonly female (36.5 vs 52.1%, P < 0.001), and had a higher burden of comorbidities (Elixhauser: 5 vs 3). Following risk-adjustment, older age (adjusted odds ratio (AOR) 1.02, 95% confidence interval (CI) 1.02-1.03) and higher burden of comorbidity (AOR 1.62, 95% CI: 1.59-1.66) were independently associated with CC ( P < 0.05). Greater annual institution PCI and MAS caseloads were independently associated with a reduced risk of CC ( P < 0.001). Furthermore, CC was associated with greater mortality (AOR 10.53, 95% CI: 8.90-12.46), respiratory complications (AOR 3.53, 95% CI: 3.18-3.91), and higher costs (β +$8,500, 95% CI: 7400-9700). On subgroup analysis, cardiac arrest revealed markedly higher mortality risk (AOR 6.86) than AMI alone (AOR 1.28). Discussion In summary, CC was associated with inferior outcomes and higher resource utilization. Furthermore, we found patient and hospital factors to be independently linked with CC risk. These findings highlight an association between institutional MAS and PCI volume and reduced CC risk, warranting further investigation into the role of center-level factors in perioperative cardiac outcomes.