[Influencing factors for major cardiovascular adverse events in elderly patients following major thoracic and abdominal surgery].

Objective: To explore the factors influencing major adverse cardiovascular events (MACE) in elderly patients undergoing major thoracic and abdominal surgery. Methods: The perioperative data of elderly patients (≥65 years) who underwent elective non-cardiac major thoracic and abdominal surgery (≥2 hours) under general anesthesia at Peking University First Hospital from November 1, 2021 to July 31, 2023, were retrospectively collected. The data included age, sex, body mass index (BMI), comorbidities, smoking history, American Society of Anesthesiologists (ASA) classification, laboratory test results, use of regional blockade, anesthesia duration, type of surgery, surgical duration, and fluid intake and output. Patients were divided into a MACE group and a non-MACE group according to whether MACE occurred postoperatively. Multivariate logistic regression analysis was used to identify the influencing factors for postoperative MACE. Results: A total of 1 915 patients were enrolled, including 1 252 males and 663 females, with a mean age of (72±5) years. The incidence of perioperative MACE was 4.6% (88/1 915). Multivariate logistic regression analysis revealed that older age (OR=1.051, 95%CI: 1.007-1.097, P=0.023), higher BMI (OR=1.111, 95%CI: 1.033-1.195, P=0.005), preoperative coronary heart disease (OR=1.934, 95%CI: 1.107-3.381, P=0.021), preoperative hyperthyroidism (OR=28.691, 95%CI: 3.207-256.640, P=0.003), higher preoperative alanine transaminase (ALT) (OR=1.007, 95%CI: 1.001-1.014, P=0.021), higher preoperative B-type natriuretic peptide (BNP)(OR=1.003, 95%CI: 1.002-1.004, P<0.001), and longer surgical duration (OR=1.003, 95%CI: 1.001-1.005, P=0.011) were risk factors for postoperative MACE, whereas intraoperative regional blockade was identified as a protective factor against postoperative MACE (OR=0.310, 95%CI: 0.189-0.508, P<0.001). Conclusions: Older age, higher BMI, preoperative hyperthyroidism, higher preoperative ALT and BNP levels, and longer surgical duration are associated with an increased risk of postoperative MACE in elderly patients undergoing major thoracic and abdominal surgery, while intraoperative regional blockade may have a protective effect against postoperative MACE.