| Abstract [eng] |
The relevance of the topic. Cardiovascular events after major abdominal surgery are associated with higher morbidity and mortality. There is no clear definitions of cardiac complications, so there are differences in their assessment and management. In order to find out the timing of these complications and to investigate their impact on 30-day all-cause mortality there was conducted an international prospective cohort study CASCADE, which was performed from January 2022 to May 2022 according to a predetermined protocol(2). The study involved 446 hospitals performing major abdominal surgeries from 28 countries across Europe (1). VUL SK study was performed according to the time limits specified in the protocol. The aim of the research: to evaluate the frequency of postoperative cardiovascular complications and their effect on 30-day postoperative mortality in major abdominal surgery. Following goals: to find out when occurs and what are the most common postoperative cardiovascular complications after major abdominal surgeries; to find out how the development of cardiovascular complications is associated with 30-day postoperative mortality; to calculate how the prevention of cardiovascular complications would affect 30-day postoperative mortality. To obtain the results there were used descriptive and comparative methods of statistics. Results. Of all included patients 24203, postoperative cardiovascular complications developed for 611 (2.5%). The most common complications were new-onset atrial fibrillation 273(41,9%), pulmonary embolism 121(18,6%) and myocardial infarction 76 (11,7%). In total, 458 (1.9%) patients died within 30 days of surgery, of which 123(26.9%) deaths were cardiac-related. Patients who developed postoperative cardiovascular complications had higher mortality rates than in those who did not (19.8% vs. 1.4%, p<0.001). It is estimated that in case all cardiovascular complications were prevented a relative risk reduction of mortality would be 21,1%. The average age of the VUL SK patients were 53 years old and a higher proportion of all subjects were women (56,4%). 13,3 % of subjects were currently in smoking status. The majority of patients had normal BMI rate (46,4%), 6,4% had overweight, 11% of patients had obesity and none of patients had morbid obesity. The most common comorbidities were cardiovascular diseases (43,6%). Elective surgeries were performed for 66,4% of cases and hepatopancreatobiliary surgery accounted almost a half of all performed surgeries (49,1%). Conclusions: 1. Cardiovascular complications after major abdominal surgery accounts 2,5% of all postoperative complications and mostly occur in the early postoperative period (median manifestation 4 days). The most common complications are new-onset atrial fibrillation (41,9%), pulmonary embolism (18,6%) and myocardial infarction (11,7%). 2. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were cardiac-related. Mortality rate of patients with cardiovascular complications was significantly higher than in those who did not developed these complications (19,8% vs 1,4%). 3. In case that all postoperative cardiovascular complications were prevented, the relative risk reduction in mortality would be 21,1% and up to 1 in 5 deaths estimated to be avoidable. |
