Cardiovascular Complications in Emergency Non-Cardiac Surgery: A RETROSPECTIVE Observational Study

Abstract

Background: Perioperative cardiovascular complications (CVC) during emergency non-cardiac surgery may occur in patients with previously undiagnosed or asymptomatic cardiac pathology. Аim: Аssessment of the frequency and determine risk factors for the development of cardiovascular complications during anesthetic care of emergency non-cardiac surgical interventions. Methods: A prospective single-center observational study was conducted, enrolling 51 patients aged 45–74 years who underwent emergency abdominal surgery (bowel obstruction 65%, hollow organ perforation 35%) between January 2023 and December 2024. High-sensitivity troponin T and NT-proBNP levels were measured before and after surgery. Clinical risk scores (RCRI, SOFA, Goldman) were assessed. ROC-analysis was performed to determine optimal cut-off values for CVC (atrial fibrillation, myocardial damage, acute myocardial infarction, decrease in left ventricular ejection fraction by more than 15% from the preoperative level, appearance or increase in areas of myocardial hypo- or akinesia according to echocardiography, hypotension requiring catecholamine support) predictors. Results: The incidence of CVC was 22% (11/51), with a mortality rate of 14% (7/51). Preoperative troponin T was significantly higher in the CVC group: 18 [16; 24] vs 12 [8; 18] pg/mL (p=0.001). ROC analysis identified a troponin T threshold of 15.3 pg/mL with an AUC of 0.78 (sensitivity 87%, specificity 69%). Postoperative NT-proBNP 204 ng/mL demonstrated an AUC of 0.70 (sensitivity 82%, specificity 44%). Intraoperative fluid volume 1630 mL had an AUC of 0.71 (sensitivity 73%, specificity 59%). SOFA scores (4 vs 2, p=0.010), RCRI (2 vs 0, p=0.004), and Goldman index (10 vs 8, p=0.034) were significantly higher in the CVC group. Postoperative atrial fibrillation occurred in 36% of CVC patients vs 2% without complications (p=0.006). Hospital stay was prolonged: 14 [11–18] vs 9 [7–12] days (p=0.005). Conclusion: A preoperative high-sensitivity troponin T level 15.3 pg/mL was the most informative predictor of CVC in emergency abdominal surgery. A combined assessment of troponin T, NT-proBNP, and intraoperative fluid volume, integrated with clinical risk scores, may improve perioperative cardiac risk stratification accuracy. Multicenter validation of the identified thresholds is warranted.