Perioperative Myocardial Injury After Major Abdominal Surgery: Hemodynamic Predictors and Early Clinical Outcomes

Abstract

Background: Intraoperative hypotension has been associated with early postoperative outcomes. The VitalDB dataset analyzed in this study lacks postoperative cardiac troponin measurements, precluding direct identification of myocardial injury after noncardiac surgery (MINS).
Methods: We analyzed 3,492 major abdominal operations and 9,135 case-linked monitoring tracks. After quality-control filtering, 3,186 cases had at least 30 minutes of usable mean arterial pressure (MAP) coverage.
Results: In 3,115 cases with complete hemodynamic-model covariates, a 10-percentage-point increase in the proportion of valid MAP time below 65 mmHg was associated with ICU admission (adjusted OR 1.41, 95% CI 1.28–1.56). There were 20 in-hospital deaths in this model population; mortality was reported descriptively due to instability of adjusted estimates. The clinical-only complete-case model included 2,207 cases and employed a different covariate specification. Published troponin-defined MINS estimates from Ji et al. [39] are provided as external evidence and are not derived from VitalDB.
Conclusion: Greater exposure to hypotension was associated with increased ICU utilization. However, interpretation is limited by differential monitoring, selection bias, clinical indication, and noncausal associations.