Incidence and Predictors of Perioperative Cardiac Events in Emergency Abdominal Surgeries: A Retrospective Study

Background Perioperative cardiac events are clinically significant complications in non-cardiac surgery and contribute to increased morbidity and prolonged hospitalization. Emergency abdominal surgeries pose additional challenges due to acute presentation, limited preoperative optimization, hemodynamic instability, systemic inflammation, and heightened sympathetic response. Region-specific data from Indian tertiary care centers are limited. Objectives This study aimed to determine the incidence of perioperative cardiac events in patients undergoing emergency appendicectomy or cholecystectomy and to identify patient-related predictors associated with the occurrence of these perioperative cardiac events. Methods A retrospective study was conducted among adult patients undergoing emergency appendicectomy or cholecystectomy at Sri Ramachandra Hospital between January 2015 and December 2025. Demographic details, cardiovascular comorbidities, type of surgery, perioperative cardiac events, and length of hospital stay were extracted from medical records. Cardiac events were classified as major or minor. Categorical variables were compared using Fisher's exact test and continuous variables using the Mann-Whitney U test. A p-value <0.05 was considered statistically significant. Results A total of 272 adult patients were included in the study. Perioperative cardiac events occurred in eight patients (2.9%), comprising four major (1.45%) and four minor (1.45%) events. Major cardiac events included hypotension requiring inotropic support and one episode of acute myocardial infarction, while minor events consisted of transient arrhythmias and self-limiting hemodynamic disturbances. No perioperative mortality was recorded. Cardiac events were more frequent in patients aged ≥60 years and in those with pre-existing cardiovascular comorbidities. Patients who developed cardiac events had a longer median hospital stay compared to those without events (6.5 vs 4 days). Conclusion Perioperative cardiac events in emergency appendicectomy and cholecystectomy are uncommon but clinically meaningful. Advanced age and pre-existing cardiovascular comorbidities are key predictors of risk. Focused perioperative assessment and vigilant monitoring are essential to reduce morbidity in emergency abdominal surgery.