Perioperative Outcomes and Factors Associated with Adverse Events in Neurosurgical Patients with Significant Cardiac Comorbidities: A Prospective Observational Cohort Study

Q: What are the key findings of this study?

Among neurosurgical patients with cardiac comorbidities, 56.5% had an adverse perioperative event, with emergency surgery strongly increasing risk (adjusted OR 17.74, 95% CI 5.44–57.83; p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Major neurosurgical procedures with established significant cardiac comorbidities (n=200). Intervention: Emergency neurosurgery (among neurosurgical patients with cardiac comorbidities) vs. Non-emergency neurosurgery. Primary outcome: Occurrence of at least one adverse perioperative event during the index hospitalization (composite of myocardial injury, perioperative MI, acute heart failure, treated arrhythmia, cardiac arrest, unplanned ICU admission, mechanical ventilation >24h, reintubation, neurological deterioration, AKI, unplanned reoperation, and in-hospital death) (OR 17.74, 95% CI 5.44–57.83, p=<0.001).

Q: What does this research mean for the field?

Neurosurgical patients with established cardiac comorbidities experience a high incidence of adverse perioperative events (56.5%), with emergency surgery significantly increasing the risk of adverse outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the incidence and patterns of adverse perioperative outcomes and identify factors associated with complications in patients with established cardiac comorbidities undergoing major neurosurgery.

Dr. Amina Sultan; Dr Lubna Naz; Rahida Rahim; Sundus Urooj; Shahid Mabood

doi:10.47144/phj.v59i5.3876

September 25, 2026Pakistan Heart JournalOpen Access

Perioperative Outcomes and Factors Associated with Adverse Events in Neurosurgical Patients with Significant Cardiac Comorbidities: A Prospective Observational Cohort Study

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Key result

Emergency neurosurgery linked to ~17.7-fold higher odds of adverse perioperative events in cardiac patients.

OR 17.74
95% CI 5.44–57.83
P<0.001
n=200

Why the study?

Neurosurgical patients with established cardiac comorbidities face substantial perioperative cardiovascular stress while requiring careful maintenance of cerebral perfusion, motivating an investigation into the frequency, pattern, and predictors of adverse perioperative outcomes in this population.

Key Points

To evaluate the incidence and patterns of adverse perioperative outcomes and identify factors associated with complications in patients with established cardiac comorbidities undergoing major neurosurgery.
Prospective observational cohort study of consecutive adult patients (N=200; mean age 59.0 ± 11.7 years; 60.0% male) with established significant cardiac comorbidities undergoing major neurosurgical procedures.
Participants were tracked from surgery through hospital discharge to evaluate a prespecified composite primary outcome of adverse perioperative events, with 30-day vital status confirmed in 196 patients (98.0%).
At least one adverse perioperative event occurred in 113 participants (56.5%; 95% CI 49.6–63.2), with study-defined MACE occurring in 40 (20.0%; 95% CI 15.0–26.1), in-hospital mortality at 4.0%, and 30-day mortality at 7.0%.
Common complications included prolonged mechanical ventilation >24 hours in 68 participants (34.0%), myocardial injury in 44 (22.0%), acute heart failure in 25 (12.5%), treated postoperative arrhythmia in 25 (12.5%), neurological deterioration in 25 (12.5%), and myocardial infarction in 11 (5.5%).
Multivariable analysis showed significantly higher odds of the composite adverse outcome with emergency surgery (adjusted OR 17.74; 95% CI 5.44–57.83; p<0.001), ASA physical-status class IV–V (adjusted OR 7.70; 95% CI 1.47–40.27; p=0.016), and increasing age per 10 years (adjusted OR 1.41; 95% CI 1.02–1.95; p=0.038).

Study Design

Type

Cohort (n=200)

Multicenter

No

Structured PICO

P

Population

200 adults (mean age 59.0 years, 40.0% female) with established significant cardiac comorbidities undergoing major neurosurgical procedures, followed through hospital discharge and up to 30 days after surgery.

E

Exposure

Major neurosurgical procedures (cranial, spinal, peripheral nerve, or other major non-tumor neurosurgical operations; elective, urgent, or emergency)

O

Outcome

Composite of at least one adverse perioperative event during the index hospitalization (including myocardial injury, perioperative myocardial infarction, acute heart failure, treated arrhythmia, cardiac arrest, unplanned ICU admission, mechanical ventilation for >24 hours, reintubation, neurological deterioration, acute kidney injury, unplanned reoperation, and in-hospital death).composite

Main Result

Odds Ratio: 17.74 (95% CI 5.44–57.83)

Absolute Event Rate: 92.7% vs 42.8%

p-value: p=<0.001

Over half of neurosurgical patients with significant cardiac comorbidities experienced an adverse perioperative event and one-fifth experienced MACE, with emergency surgery, ASA class IV–V, and older age independently increasing risk.

Limitations

No comparison group of neurosurgical patients without cardiac disease was included
Single-center observational design with potential for residual and unmeasured confounding
Baseline perioperative characteristics were not masked to outcome assessors, creating potential for observer bias
Incomplete postoperative cardiac troponin surveillance (76.0% completed the full protocol)
Near-separation and sparse-data bias for emergency surgery (only 4 emergency patients remained event-free)
Single-center study without a comparison group of neurosurgical patients without cardiac disease
Baseline perioperative characteristics were not masked to outcome assessors, so observer bias cannot be completely excluded
Incomplete troponin surveillance was a potential source of outcome-detection bias
Residual and unmeasured confounding remained possible because of the observational study design
Sample size was calculated to estimate an outcome proportion rather than to develop a clinically validated multivariable prediction model

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Implication

High perioperative risk warrants caution in cardiac neurosurgery patients; leaves open whether targeted interventions improve outcomes.

Abstract

Objectives: Neurosurgical patients with established cardiac comorbidities represent a clinically vulnerable population because major neurosurgical procedures impose substantial cardiovascular and physiological stress while requiring careful maintenance of cerebral perfusion and systemic haemodynamic stability. This study aimed to determine the frequency and pattern of adverse perioperative outcomes and to explore clinical and perioperative factors associated with adverse events among neurosurgical patients with significant cardiac comorbidities. Methodology: This prospective observational cohort study included consecutive adults with established significant cardiac comorbidities undergoing major neurosurgical procedures. Participants were followed from the index operation through hospital discharge, with vital status reassessed 30 days after surgery. The prespecified primary outcome was the occurrence of at least one adverse perioperative event during the index hospitalization. Secondary outcomes included study-defined major adverse cardiac events (MACE), individual cardiac, neurological, respiratory and renal complications, critical-care utilization, length of hospital stay, and mortality. Results: A total of 200 participants were analyzed; mean age was 59.0 ± 11.7 years, and 120 (60.0%) were male. At least one adverse perioperative event occurred in 113 participants (56.5%; 95% CI 49.6–63.2), while 40 (20.0%; 95% CI 15.0–26.1) experienced study-defined MACE. Myocardial injury occurred in 44 (22.0%), perioperative myocardial infarction in 11 (5.5%), acute heart failure in 25 (12.5%), treated postoperative arrhythmia in 25 (12.5%), prolonged ventilation >24 hours in 68 (34.0%), and neurological deterioration in 25 (12.5%). In-hospital mortality was 4.0%, and 30-day mortality was 7.0%. In multivariable analysis, emergency surgery was associated with substantially higher odds of the composite adverse outcome (adjusted OR 17.74; 95% CI 5.44–57.83; p<0.001), as were ASA physical-status class IV–V (adjusted OR 7.70; 95% CI 1.47–40.27; p=0.016) and increasing age per 10 years (adjusted OR 1.41; 95% CI 1.02–1.95; p=0.038). Conclusion: Neurosurgical patients with established cardiac comorbidities experienced a substantial burden of perioperative adverse events, with more than half experiencing at least one component of the prespecified composite outcome and one-fifth experiencing study-defined MACE. Emergency surgery, advanced ASA physical status, and increasing age were associated with higher adjusted odds of adverse perioperative outcomes.

Discussion

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Cite This Study

Sultan et al. (2026) conducted a cohort in Major neurosurgical procedures with established significant cardiac comorbidities (n=200). Emergency neurosurgery (among neurosurgical patients with cardiac comorbidities) vs. Non-emergency neurosurgery was evaluated on Occurrence of at least one adverse perioperative event during the index hospitalization (composite of myocardial injury, perioperative MI, acute heart failure, treated arrhythmia, cardiac arrest, unplanned ICU admission, mechanical ventilation >24h, reintubation, neurological deterioration, AKI, unplanned reoperation, and in-hospital death) (OR 17.74, 95% CI 5.44–57.83, p=<0.001). Among neurosurgical patients with cardiac comorbidities, 56.5% had an adverse perioperative event, with emergency surgery strongly increasing risk (adjusted OR 17.74, 95% CI 5.44–57.83; p<0.001).

synapsesocial.com/papers/6af0dba03c845ca7837cedb9 https://doi.org/10.47144/phj.v59i5.3876

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Perioperative Outcomes and Factors Associated with Adverse Events in Neurosurgical Patients with Significant Cardiac Comorbidities: A Prospective Observational Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Perioperative Outcomes and Factors Associated with Adverse Events in Neurosurgical Patients with Significant Cardiac Comorbidities: A Prospective Observational Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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