Patient- and Institution-Level Factors Associated With Intraoperative Cardiac Arrest During Major Noncardiac Surgery

Intraoperative cardiac arrest (IOCA) is a rare but catastrophic event with significant morbidity, mortality, and health care costs. This study aimed to characterize the frequency, risk factors, and outcomes of IOCA.

Adults undergoing noncardiac surgery were identified in the 2016 to 2021 National Inpatient Sample. IOCA events were identified using the relevant International Classification of Diseases code. Multivariable regression models examined factors independently associated with IOCA and in-hospital mortality. The significance of temporal trends was calculated using Cuzick's nonparametric test.

Among 2671,834 noncardiac surgical admissions, 1294 (0.05%) experienced IOCA. The incidence increased from 0.05% to 0.06% during the study period, coinciding with an increase in nonelective operations during the coronavirus disease-2019 (COVID-19) pandemic. IOCA was associated with a 39.3% in-hospital mortality rate and increases in length of stay and hospitalization costs. Key risk factors for IOCA included advanced age, male sex, Black race (adjusted odds ratio [AOR] 1.40, 95% CI, 1.20-1.65), low-income status (AOR 1.21, 95% CI, 1.02-1.43), treatment at government nonfederal hospitals (AOR 1.22, 95% CI, 1.08-1.50), high-risk surgical procedures, and significant comorbidities such as congestive heart failure, cardiac arrhythmias, and valvular disease.

Despite the initial reduction in the incidence of IOCA, this study highlights a temporal increase coinciding with the COVID-19 pandemic and an increase in nonelective surgeries. Future research should explore more granular predictors of IOCA and its outcomes to develop targeted interventions for at-risk populations and tailor guidelines to manage emerging challenges in population health.