Intraoperative predictors of major adverse cardiovascular and cerebrovascular events risk following hepatobiliary and pancreatic surgery: insights from the INSPIRE dataset.

BACKGROUND

Major adverse cardiovascular and cerebrovascular events (MACCE) pose significant challenges in hepatobiliary and pancreatic surgeries, contributing to increased morbidity, mortality, and healthcare burdens. Accurate identification of perioperative risk factors remains critical yet underexplored due to limited large-scale data. This study aimed to find intraoperative predictors of MACCE within 30 (MACCE-30) and 90 days (MACCE-90) post-surgery using the INSPIRE database.

METHODS

A retrospective cohort of 6135 patients from Seoul National University Hospital was analyzed. MACCE was defined as angina, myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital mortality. Variables including patient characteristics, intraoperative factors (e.g., estimated blood loss [EBL], crystalloid volume), and comorbidities were extracted. Univariate Cox proportional hazards models identified variables (p < 0.2) for multivariate analysis, with Kaplan-Meier plots visualizing survival differences.

RESULTS

Of 6135 patients, 179 experienced MACCE-90. Multivariate analysis identified male sex (HR 1.88, 95% CI 1.27-2.78, p < 0.01), EBL (HR 1.19, 95% CI 1.03-1.37, p = 0.02), and crystalloid infusion volume (HR 1.29, 95% CI 1.00-1.65, p = 0.05) as significant predictors of MACCE-90. Mean EBL was 565 mL (MACCE) versus 357 mL (non-MACCE), and crystalloid volume was 498 mL versus 486 mL. We observed no significant difference in early survival based on sex, EBL, or infused crystaollioids.

CONCLUSION

Male sex, higher EBL, and crystalloid volumes predict MACCE-90. Optimized management and refined protocols are needed.