Perioperative Outcomes and Factors Associated with Adverse Events in Neurosurgical Patients with Significant Cardiac Comorbidities: A Prospective Observational Cohort Study

Abstract

Objectives: Neurosurgical patients with established cardiac comorbidities represent a clinically vulnerable population because major neurosurgical procedures impose substantial cardiovascular and physiological stress while requiring careful maintenance of cerebral perfusion and systemic haemodynamic stability. This study aimed to determine the frequency and pattern of adverse perioperative outcomes and to explore clinical and perioperative factors associated with adverse events among neurosurgical patients with significant cardiac comorbidities. Methodology: This prospective observational cohort study included consecutive adults with established significant cardiac comorbidities undergoing major neurosurgical procedures. Participants were followed from the index operation through hospital discharge, with vital status reassessed 30 days after surgery. The prespecified primary outcome was the occurrence of at least one adverse perioperative event during the index hospitalization. Secondary outcomes included study-defined major adverse cardiac events (MACE), individual cardiac, neurological, respiratory and renal complications, critical-care utilization, length of hospital stay, and mortality. Results: A total of 200 participants were analyzed; mean age was 59.0 ± 11.7 years, and 120 (60.0%) were male. At least one adverse perioperative event occurred in 113 participants (56.5%; 95% CI 49.6–63.2), while 40 (20.0%; 95% CI 15.0–26.1) experienced study-defined MACE. Myocardial injury occurred in 44 (22.0%), perioperative myocardial infarction in 11 (5.5%), acute heart failure in 25 (12.5%), treated postoperative arrhythmia in 25 (12.5%), prolonged ventilation >24 hours in 68 (34.0%), and neurological deterioration in 25 (12.5%). In-hospital mortality was 4.0%, and 30-day mortality was 7.0%. In multivariable analysis, emergency surgery was associated with substantially higher odds of the composite adverse outcome (adjusted OR 17.74; 95% CI 5.44–57.83; p<0.001), as were ASA physical-status class IV–V (adjusted OR 7.70; 95% CI 1.47–40.27; p=0.016) and increasing age per 10 years (adjusted OR 1.41; 95% CI 1.02–1.95; p=0.038). Conclusion: Neurosurgical patients with established cardiac comorbidities experienced a substantial burden of perioperative adverse events, with more than half experiencing at least one component of the prespecified composite outcome and one-fifth experiencing study-defined MACE. Emergency surgery, advanced ASA physical status, and increasing age were associated with higher adjusted odds of adverse perioperative outcomes.