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

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Health Services Research

Background:

• Intraoperative cardiac arrest (IOCA) is a rare but severe complication of noncardiac surgery.
• It leads to significant morbidity, mortality, and increased healthcare costs.
• Understanding its incidence, risk factors, and outcomes is crucial for patient safety.

Purpose of the Study:

• To characterize the frequency, risk factors, and outcomes of IOCA in adults undergoing noncardiac surgery.
• To investigate temporal trends in IOCA incidence.
• To identify patient and hospital factors associated with IOCA and in-hospital mortality.

Main Methods:

• Analysis of the 2016-2021 National Inpatient Sample for adult noncardiac surgical admissions.
• Identification of IOCA events using International Classification of Diseases codes.
• Multivariable regression and Cuzick's nonparametric test for temporal trends.

Main Results:

• 1294 (0.05%) of 2,671,834 admissions experienced IOCA.
• Incidence rose from 0.05% to 0.06%, linked to increased nonelective surgeries during the COVID-19 pandemic.
• IOCA associated with 39.3% in-hospital mortality, longer stays, and higher costs.
• Risk factors included advanced age, male sex, Black race, low income, government hospitals, high-risk procedures, and comorbidities (CHF, arrhythmias, valvular disease).

Conclusions:

• A temporal increase in IOCA incidence was observed, coinciding with the COVID-19 pandemic and rise in nonelective surgeries.
• IOCA carries a high mortality rate and significant economic burden.
• Further research needed for granular predictors and targeted interventions for at-risk populations.