“Epidemiology and Outcomes of In-Hospital Cardiac Arrest in Adult Surgical Patients: A Comparison of Cardiac and Non-Cardiac Surgeries”

Background In-hospital cardiac arrest (IHCA) after surgery remains a catastrophic event, with outcomes influenced by patient profile, surgical type, and perioperative monitoring. There is limited evidence comparing IHCA patterns between cardiac and non-cardiac surgery patients in low- and middle-income settings. Methods This retrospective observational cohort study included adult patients who developed IHCA after cardiac or non-cardiac surgical procedures at a tertiary care center from January 2022 to December 2024. Demographic characteristics, perioperative factors, arrest rhythms, and clinical outcomes were collected from the hospital records and the cardiopulmonary resuscitation database. The primary outcome was survival to hospital discharge. Secondary outcomes included ROSC, arrest rhythm, CPR duration, and neurological status at discharge. Results During the study period, 55 postoperative IHCA events met the inclusion criteria: 15 occurred after cardiac surgery and 40 after non-cardiac surgery, with incidences of 11.76 and 1.02 per 1,000 procedures. Cardiac surgery patients had higher complexity, with more emergency operations (66.7%), abnormal pre-operative echocardiographic findings, and prolonged operative and bypass time. Cardiac causes were predominant in both groups (53% cardiac vs. 72.5% general surgery). Shockable rhythms were more common after cardiac surgery (46.6% vs. 10%), yet ROSC rates were identical (40% in both groups). Survival to discharge was 13.3% in cardiac surgery patients and 22.5% in non-cardiac surgery patients (odds ratio 0.53; 95% CI 0.10–2.79). Among non-cardiac surgical patients, 8 of 9 survivors had a CPC score of 1, while 1 had a CPC score >1. Both cardiac surgical survivors had a CPC score of 1. Conclusion Postoperative IHCA is associated with high mortality in both surgical groups. Emergency surgical status, multiple comorbidities, and prolonged bypass time increase the risk of mortality in cardiac surgery patients. Sustained improvements in monitoring, rapid response systems, and timely defibrillation, especially in non-monitored areas, may enhance postoperative resuscitation outcomes in resource-limited settings.